Provider Demographics
NPI:1265080287
Name:BOWRING, JENNIFER BERNADETTE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BERNADETTE
Last Name:BOWRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W NORTHWEST HWY APT 3215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5168
Mailing Address - Country:US
Mailing Address - Phone:469-877-3782
Mailing Address - Fax:
Practice Address - Street 1:9101 N CENTRAL EXPY STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5945
Practice Address - Country:US
Practice Address - Phone:469-800-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant