Healthcare Provider Details

I. General information

NPI: 1629424619
Provider Name (Legal Business Name): JENNIFER BOWLING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DRIVE
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-4688
  • Fax: 859-301-2607
Mailing address:
  • Phone: 859-301-4688
  • Fax: 859-301-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3010276
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010276
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: