Provider Demographics
NPI:1841632486
Name:BOWEN, LINDSEY HOPKINS (PA-AA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:HOPKINS
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PA-AA
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:MARIE
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-AA
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-8700
Mailing Address - Fax:414-259-1522
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-354-3666
Practice Address - Fax:706-543-5744
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006987367H00000X
WI110367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003140116BOtherMEDICAID
GA003140116AMedicaid
WI1841632486Medicaid