Provider Demographics
NPI:1457058711
Name:BOWEN, JEFFERY MICHAEL (FNP)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:MICHAEL
Last Name:BOWEN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35907-0858
Mailing Address - Country:US
Mailing Address - Phone:256-996-4661
Mailing Address - Fax:
Practice Address - Street 1:3066 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35907-0858
Practice Address - Country:US
Practice Address - Phone:256-996-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-155731163W00000X, 363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program