Healthcare Provider Details

I. General information

NPI: 1841154655
Provider Name (Legal Business Name): JACOB BOWLES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 HARTLEY WAY
PEARISBURG VA
24134-2471
US

IV. Provider business mailing address

18720 OLD HOMESTEAD WAY
ABINGDON VA
24211-6692
US

V. Phone/Fax

Practice location:
  • Phone: 540-921-6000
  • Fax:
Mailing address:
  • Phone: 276-698-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: