Healthcare Provider Details

I. General information

NPI: 1881038834
Provider Name (Legal Business Name): MISTY D BOWEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL DR
HANNIBAL MO
63401-6877
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 573-221-5250
  • Fax: 573-231-3716
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-277-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014041606
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: