Healthcare Provider Details

I. General information

NPI: 1750248704
Provider Name (Legal Business Name): JADE AUDRIE BOWMAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2001 ENTERPRISE DR
FOREST VA
24551-2653
US

IV. Provider business mailing address

1810 BROADWAY ST UNIT 209
LYNCHBURG VA
24501-5605
US

V. Phone/Fax

Practice location:
  • Phone: 434-386-8983
  • Fax:
Mailing address:
  • Phone: 276-608-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: