Healthcare Provider Details

I. General information

NPI: 1982212072
Provider Name (Legal Business Name): ALEXANDRIA BOWER-NELSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 W MAIN ST
KALAMAZOO MI
49009-8925
US

IV. Provider business mailing address

6428 E S AVE
VICKSBURG MI
49097-9475
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7030
  • Fax: 269-286-7031
Mailing address:
  • Phone: 231-342-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601009946
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601009946TMP20
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: