Healthcare Provider Details

I. General information

NPI: 1508563875
Provider Name (Legal Business Name): ALEXANDRIA BELLE BOWERING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 E SUNSHINE ST
SPRINGFIELD MO
65804-2047
US

IV. Provider business mailing address

2730 E SUNSHINE ST
SPRINGFIELD MO
65804-2047
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-0600
  • Fax:
Mailing address:
  • Phone: 417-883-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023004711
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: