Provider Demographics
NPI:1912625385
Name:BOWLDS, JOSEPH RYAN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:BOWLDS
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 1:1030 MONARCH ST
Mailing Address - Street 2:SUITES 100 & 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1820
Mailing Address - Country:US
Mailing Address - Phone:859-296-3141
Mailing Address - Fax:859-296-3144
Practice Address - Street 1:1030 MONARCH ST STE 100&200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1843
Practice Address - Country:US
Practice Address - Phone:859-214-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health