Provider Demographics
NPI:1932653938
Name:BOWLIN, LAUREN M (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:SMALLWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 950112
Mailing Address - Street 2:DEPT #52387
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0112
Mailing Address - Country:US
Mailing Address - Phone:781-280-1693
Mailing Address - Fax:781-276-6410
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:781-280-1693
Practice Address - Fax:781-276-6410
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010583363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner