Provider Demographics
NPI:1124817630
Name:BOWMAN, DEVEN LAVELLE
Entity type:Individual
Prefix:
First Name:DEVEN
Middle Name:LAVELLE
Last Name:BOWMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 DALLAS RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-9313
Mailing Address - Country:US
Mailing Address - Phone:307-689-3668
Mailing Address - Fax:
Practice Address - Street 1:702 DALLAS RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-9313
Practice Address - Country:US
Practice Address - Phone:307-689-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health