Provider Demographics
NPI:1821605767
Name:BOWLIN, JACHOB BRADLEY (MBA, MSN, CRNA)
Entity Type:Individual
Prefix:MR
First Name:JACHOB
Middle Name:BRADLEY
Last Name:BOWLIN
Suffix:
Gender:M
Credentials:MBA, MSN, CRNA
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Mailing Address - Street 1:4216 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9615
Mailing Address - Country:US
Mailing Address - Phone:606-765-7759
Mailing Address - Fax:
Practice Address - Street 1:770 HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2545
Practice Address - Country:US
Practice Address - Phone:606-765-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018828367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered