Provider Demographics
NPI:1396725040
Name:BOWLES, AMY M (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BOWLES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:287 COMMONWEALTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1820
Mailing Address - Country:US
Mailing Address - Phone:276-632-2966
Mailing Address - Fax:276-632-0841
Practice Address - Street 1:287 COMMONWEALTH BLVD W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1820
Practice Address - Country:US
Practice Address - Phone:276-632-2966
Practice Address - Fax:276-632-0841
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ58643Medicare UPIN
009227H20Medicare PIN