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General NPI Number Information
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NPI Number | 1063876589
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Entity Type | Individual
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Provider Name | ALEXIS NICOLE BOWDER MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 325 N STATE OF FRANKLIN RD FL 3
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6171
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Country | US
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Telephone | 423-439-7201
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 699
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684-0699
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 73261
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License Number State | TN
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