Provider Demographics
NPI:1184101743
Name:BOWEN, DEAN LEROY (PMHNP-BC (APRA))
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:LEROY
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PMHNP-BC (APRA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W. BELL AVE.
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3404
Mailing Address - Country:US
Mailing Address - Phone:423-634-8884
Mailing Address - Fax:423-654-0813
Practice Address - Street 1:420 W. BELL AVE.
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3404
Practice Address - Country:US
Practice Address - Phone:423-634-8884
Practice Address - Fax:423-654-0813
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24511363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty