Healthcare Provider Details

I. General information

NPI: 1174892822
Provider Name (Legal Business Name): CLAUDIA BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 HIGHWAY 35 S
FOREST MS
39074-8829
US

IV. Provider business mailing address

PO BOX 1100
MAGEE MS
39111-1100
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-4771
  • Fax: 601-469-4724
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-849-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR855499
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: