Healthcare Provider Details

I. General information

NPI: 1629572896
Provider Name (Legal Business Name): MRS. ALEX JASMINE BOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 11/08/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 CLEAR SKY CT STE C
CLARKSVILLE TN
37043-5951
US

IV. Provider business mailing address

291 CLEAR SKY CT STE C
CLARKSVILLE TN
37043-5951
US

V. Phone/Fax

Practice location:
  • Phone: 931-682-6195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45560
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: