Provider Demographics
NPI:1821353046
Name:BOWLING, EMILY VIRGINIA (MS RD)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:VIRGINIA
Last Name:BOWLING
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4686 HICKORY SIGNPOST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2462
Mailing Address - Country:US
Mailing Address - Phone:210-464-0313
Mailing Address - Fax:
Practice Address - Street 1:1078 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4502
Practice Address - Country:US
Practice Address - Phone:850-682-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6317133V00000X
TXDT81061133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered