Provider Demographics
NPI:1639575384
Name:BOWDEN, HALEY JEANETTE (APRN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:JEANETTE
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:105 ST HWY 1947 A
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-6825
Practice Address - Country:US
Practice Address - Phone:606-475-0152
Practice Address - Fax:606-474-4240
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16660-NP363LF0000X
KY3008827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3910006415Medicaid
OH0116292Medicaid
KY7100341150Medicaid
OH0116292Medicaid
KYK180780Medicare PIN