Healthcare Provider Details

I. General information

NPI: 1326432253
Provider Name (Legal Business Name): JAMIE ANNE PREVEDEL BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE PREVEDEL

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 N 500 W
PROVO UT
84604-3380
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-8310
  • Fax: 413-794-1767
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11284221-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11284221-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11284221-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: