MEDICARE: MRS. SUSAN MARY BOWLIN FNP-BC, ACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP113519	TX
2	363LA2100X	Acute Care Nurse Practitioner	AP113519	TX

General Provider Information

NPI Number	:	1144225178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MARY BOWLIN FNP-BC, ACNP-BC

Provider Business Mailing Address
First Line	:	2416 BELVEDERE LN
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-5699
Country	:	US
Telephone Number	:	972-849-2190
Fax Number	:	817-305-5069

Provider Business Practice Location Address
First Line	:	2201 SPINKS RD STE 230
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4451
Country	:	US
Telephone Number	:	972-430-5252
Fax Number	:	972-573-0103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/15/2024

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