Provider Demographics
NPI:1740308543
Name:BOWEN, PAMELA GRAY (CRNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:GRAY
Last Name:BOWEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1015 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-3510
Mailing Address - Country:US
Mailing Address - Phone:205-744-8418
Mailing Address - Fax:
Practice Address - Street 1:1720 2ND AVE S
Practice Address - Street 2:NB 416
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0113
Practice Address - Country:US
Practice Address - Phone:205-934-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1058291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP44509Medicare UPIN