Healthcare Provider Details

I. General information

NPI: 1790376739
Provider Name (Legal Business Name): PHILIP BOWLES DNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 830
INDIANAPOLIS IN
46260-2096
US

IV. Provider business mailing address

8402 HARCOURT RD STE 830
INDIANAPOLIS IN
46260-2096
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-8857
  • Fax:
Mailing address:
  • Phone: 317-338-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011329A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: