Healthcare Provider Details

I. General information

NPI: 1073244059
Provider Name (Legal Business Name): JESSICA BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 MARKET ST
PARKERSBURG WV
26101-4323
US

IV. Provider business mailing address

25 HARPER LN
GANDEEVILLE WV
25243-9287
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-5420
  • Fax: 304-865-5423
Mailing address:
  • Phone: 304-786-9848
  • Fax: 304-471-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: