Healthcare Provider Details

I. General information

NPI: 1689886236
Provider Name (Legal Business Name): PENNY JEAN BOWEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BRECKENRIDGE GRDHD
OWENSBORO KY
42302
US

IV. Provider business mailing address

1600 BRECKENRIDGE GREEN RIVER DISTRICT HEALTH DEPT
OWENSBORO KY
42302
US

V. Phone/Fax

Practice location:
  • Phone: 270-686-7747
  • Fax: 270-686-5982
Mailing address:
  • Phone: 270-686-7747
  • Fax: 270-686-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN1030737
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: