Healthcare Provider Details

I. General information

NPI: 1255018727
Provider Name (Legal Business Name): AMBER LEA BOWLIN MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER LEA BRYAN

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE DR
RICHMOND VA
23233-7632
US

IV. Provider business mailing address

10740 TRENTS BRIDGE RD
CHESTERFIELD VA
23838-4423
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 804-647-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: