Healthcare Provider Details

I. General information

NPI: 1205558384
Provider Name (Legal Business Name): CARISSA BOWIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 WESTRIDGE ST SW
BONDURANT IA
50035-1507
US

IV. Provider business mailing address

3390 NE 96TH ST
ALTOONA IA
50009-8717
US

V. Phone/Fax

Practice location:
  • Phone: 515-577-4058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number118434
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: