Healthcare Provider Details

I. General information

NPI: 1891673703
Provider Name (Legal Business Name): JENNIFER BOWMAN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WHITE OAK DR
CONWAY AR
72034-3443
US

IV. Provider business mailing address

41 WHITE OAK DR
CONWAY AR
72034-3443
US

V. Phone/Fax

Practice location:
  • Phone: 505-206-2908
  • Fax:
Mailing address:
  • Phone: 505-206-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN-79442
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: