Healthcare Provider Details

I. General information

NPI: 1154258234
Provider Name (Legal Business Name): ROBERT ANTHONY BOWMAN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KIASHA MONIQUE BOWMAN

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 S WOODHAVEN ST
BATON ROUGE LA
70815-4885
US

IV. Provider business mailing address

1836 S WOODHAVEN ST
BATON ROUGE LA
70815-4885
US

V. Phone/Fax

Practice location:
  • Phone: 225-397-9173
  • Fax:
Mailing address:
  • Phone: 225-397-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number4819235
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: