Healthcare Provider Details

I. General information

NPI: 1083367817
Provider Name (Legal Business Name): JESSICA BOWMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

IV. Provider business mailing address

9649 COUNTY ROAD 73
FILLMORE MO
64449-9183
US

V. Phone/Fax

Practice location:
  • Phone: 660-686-2211
  • Fax:
Mailing address:
  • Phone: 816-387-1519
  • Fax: 660-686-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2021046379
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: