Provider Demographics
NPI:1568676021
Name:BOWLING, SONYA BROOKE (DI)
Entity Type:Individual
Prefix:MISS
First Name:SONYA
Middle Name:BROOKE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 ELSWICK ROAD
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:JONANCY
Mailing Address - State:KY
Mailing Address - Zip Code:41538
Mailing Address - Country:US
Mailing Address - Phone:606-639-6619
Mailing Address - Fax:
Practice Address - Street 1:793 ELSWICK ROAD
Practice Address - Street 2:
Practice Address - City:JONANCY
Practice Address - State:KY
Practice Address - Zip Code:41538
Practice Address - Country:US
Practice Address - Phone:606-639-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor