Healthcare Provider Details

I. General information

NPI: 1801492830
Provider Name (Legal Business Name): HEATHER BOWERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HUGH RULE DR
ROCKFORD TN
37853-3037
US

IV. Provider business mailing address

105 HUGH RULE DR
ROCKFORD TN
37853-3037
US

V. Phone/Fax

Practice location:
  • Phone: 540-958-4398
  • Fax:
Mailing address:
  • Phone: 540-958-4398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500002211
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024183700
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28640
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: