Provider Demographics
NPI:1578949202
Name:BOWMAN, MELISSA (PPCNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 FOUNDERS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-2979
Mailing Address - Country:US
Mailing Address - Phone:585-705-3471
Mailing Address - Fax:
Practice Address - Street 1:316 SECOR ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6343
Practice Address - Country:US
Practice Address - Phone:432-620-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382542-1363LP0200X
TXAP132564363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics