Provider Demographics
NPI:1972976025
Name:BOWEN-PERKINS, MIRANDA NICHOLE (APRN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NICHOLE
Last Name:BOWEN-PERKINS
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 1:2708 S RIFE MEDICAL LN
Mailing Address - Street 2:140
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-3750
Mailing Address - Fax:479-338-3799
Practice Address - Street 1:2708 S RIFE MEDICAL LN
Practice Address - Street 2:140
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-3750
Practice Address - Fax:479-338-3799
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004597363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner