Provider Demographics
NPI:1881833085
Name:BOWKLEY, BROOKE N (PA)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:N
Last Name:BOWKLEY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:UMPHLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5801 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6243
Mailing Address - Country:US
Mailing Address - Phone:303-518-3963
Mailing Address - Fax:
Practice Address - Street 1:5801 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6243
Practice Address - Country:US
Practice Address - Phone:303-518-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY468363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical