Healthcare Provider Details

I. General information

NPI: 1811147036
Provider Name (Legal Business Name): DODI LYNN BOWEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 KANAWHA BLVD W
CHARLESTON WV
25387-2536
US

IV. Provider business mailing address

3415 MACCORKLE SEAVE
CHARLESTON WV
25304-1334
US

V. Phone/Fax

Practice location:
  • Phone: 304-768-8523
  • Fax: 304-941-1918
Mailing address:
  • Phone: 304-388-8380
  • Fax: 304-388-8395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number47646
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: