Provider Demographics
NPI:1013441013
Name:BOWLER, JENNIFER NICOLE (DPN, PNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:BOWLER
Suffix:
Gender:F
Credentials:DPN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 HOSPITAL DR
Mailing Address - Street 2:P O BOX 1239
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6890
Mailing Address - Country:US
Mailing Address - Phone:573-629-3440
Mailing Address - Fax:573-629-3416
Practice Address - Street 1:6500 HOSPITAL DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6890
Practice Address - Country:US
Practice Address - Phone:573-629-3440
Practice Address - Fax:573-629-3416
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011709163WP0200X
MO2017019292363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics