Provider Demographics
NPI:1598339699
Name:BOWLIN, ELIZABETH YANCEY (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YANCEY
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-9035
Mailing Address - Country:US
Mailing Address - Phone:434-210-0743
Mailing Address - Fax:
Practice Address - Street 1:3762 DURHAM RD STE B
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-2741
Practice Address - Country:US
Practice Address - Phone:434-447-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181357363L00000X
NC5014976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner