Provider Demographics
NPI:1801624580
Name:BOWEN, JERMAINE M
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 E DEER SPRINGS WAY APT 2166
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1471
Mailing Address - Country:US
Mailing Address - Phone:702-357-1184
Mailing Address - Fax:
Practice Address - Street 1:7260 W AZURE DR STE 140-144
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-7999
Practice Address - Country:US
Practice Address - Phone:702-789-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician