Healthcare Provider Details

I. General information

NPI: 1972271369
Provider Name (Legal Business Name): LINDA MARIE BOWEN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 WALNUT GROVE RD
MEMPHIS TN
38120-2145
US

IV. Provider business mailing address

7541 PINE KNOT PT
SOUTHAVEN MS
38671-5620
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-2800
  • Fax: 901-226-2802
Mailing address:
  • Phone: 662-772-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number904562
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28635
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number28635
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number904562
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number904562
License Number StateMS
# 6
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0000028635
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: