Healthcare Provider Details

I. General information

NPI: 1861140568
Provider Name (Legal Business Name): AMY MICHELLE BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY HOLT

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MEDICAL PKWY
CLAREMORE OK
74017-1088
US

IV. Provider business mailing address

1122 W 15TH ST
CLAREMORE OK
74017-2604
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-0770
  • Fax:
Mailing address:
  • Phone: 918-373-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberBHC
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: