Healthcare Provider Details

I. General information

NPI: 1104732627
Provider Name (Legal Business Name): TERESA BOWDEN CBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DARBY CREEK RD STE 56A
LEXINGTON KY
40509-2610
US

IV. Provider business mailing address

622 WOODDUCK LN
GEORGETOWN KY
40324-9251
US

V. Phone/Fax

Practice location:
  • Phone: 502-603-7878
  • Fax:
Mailing address:
  • Phone: 502-603-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number3912
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: