Healthcare Provider Details

I. General information

NPI: 1457596058
Provider Name (Legal Business Name): MYCHELLE YVONNE BOWERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 CENTER STREET SUITE R
TACOMA WA
98409
US

IV. Provider business mailing address

8325 59TH STREET CT W
UNIVERSITY PLACE WA
98467-4058
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-674-5871
  • Fax: 206-694-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60055073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: