Healthcare Provider Details

I. General information

NPI: 1437014602
Provider Name (Legal Business Name): MRS. JENELL DENENE BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 RIVERSIDE PKWY NE STE 300
ROME GA
30161-2939
US

IV. Provider business mailing address

509 BROOKLANE ST
METROPOLIS IL
62960-1122
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-9151
  • Fax: 706-291-1447
Mailing address:
  • Phone: 706-291-9151
  • Fax: 706-291-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN220294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: