Provider Demographics
NPI:1619374709
Name:BOWMAN, JENNIFER (RD, LD, CLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:3029 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9143
Mailing Address - Country:US
Mailing Address - Phone:502-645-5383
Mailing Address - Fax:
Practice Address - Street 1:400 E GRAY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1740
Practice Address - Country:US
Practice Address - Phone:502-574-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY957472133V00000X
KY1921133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered