Provider Demographics
NPI:1396550547
Name:BOWMAN, JORDAN (PMHNP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1318
Mailing Address - Country:US
Mailing Address - Phone:208-716-1958
Mailing Address - Fax:
Practice Address - Street 1:623 W SANFORD ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1318
Practice Address - Country:US
Practice Address - Phone:208-716-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5871743363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health