Provider Demographics
NPI:1962657676
Name:BOWLIN, CONNIE L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BUSINESS CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2744
Mailing Address - Country:US
Mailing Address - Phone:713-932-5757
Mailing Address - Fax:713-932-5750
Practice Address - Street 1:110 MEMORIAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-3411
Practice Address - Fax:936-291-4378
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245572207P00000X, 363LF0000X
TXAP117412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB111283Medicare PIN