Provider Demographics
NPI:1922192293
Name:BOWLIN, JIMMY WAYNE JR (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:WAYNE
Last Name:BOWLIN
Suffix:JR
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:AL
Mailing Address - Zip Code:35905-9603
Mailing Address - Country:US
Mailing Address - Phone:256-442-5937
Mailing Address - Fax:
Practice Address - Street 1:760 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4147
Practice Address - Country:US
Practice Address - Phone:256-543-1100
Practice Address - Fax:256-543-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-056721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51530773OtherPROVIDER
ALS73577Medicare UPIN