Provider Demographics
NPI:1609073626
Name:BOWERSOCK, ALISA ROSEANN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:ROSEANN
Last Name:BOWERSOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 FRIST BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2056
Mailing Address - Country:US
Mailing Address - Phone:615-391-0800
Mailing Address - Fax:615-391-0431
Practice Address - Street 1:5651 FRIST BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076
Practice Address - Country:US
Practice Address - Phone:615-391-0800
Practice Address - Fax:615-391-0431
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2318207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101017318OtherINTERN
TNT030270764OtherPTAN