Provider Demographics
NPI:1245264738
Name:BOWERY, PATRICIA ANKE (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANKE
Last Name:BOWERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325M GLEN ECHO LANE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-9131
Mailing Address - Country:US
Mailing Address - Phone:919-859-7809
Mailing Address - Fax:
Practice Address - Street 1:527 KEISLER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-9306
Practice Address - Country:US
Practice Address - Phone:919-859-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046VROtherBLUE CROSS BLUE SHIELD