Healthcare Provider Details

I. General information

NPI: 1609110352
Provider Name (Legal Business Name): BEVERLY LUCINDA BOWLING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY LUCINDA MEEKS

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 FERN VALLEY RD
LOUISVILLE KY
40219-1916
US

IV. Provider business mailing address

PO BOX 72700
LOUISVILLE KY
40272-0700
US

V. Phone/Fax

Practice location:
  • Phone: 502-964-3381
  • Fax:
Mailing address:
  • Phone: 502-380-5503
  • Fax: 502-937-3807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3007778
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: