Provider Demographics
NPI:1609110352
Name:BOWLING, BEVERLY LUCINDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:LUCINDA
Last Name:BOWLING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:LUCINDA
Other - Last Name:MEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 72700
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-0700
Mailing Address - Country:US
Mailing Address - Phone:502-380-5503
Mailing Address - Fax:502-937-3807
Practice Address - Street 1:3625 FERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1916
Practice Address - Country:US
Practice Address - Phone:502-964-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007778363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health