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General NPI Number Information
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NPI Number | 1134498579
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Entity Type | Individual
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Provider Name | AMANDA BROOKS BOWEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 11208 STATESVILLE RD SUITE 300
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7635
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Country | US
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Telephone | 704-659-9000
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Fax | 704-659-9009
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Provider Business Mailing Address
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Address Line | 11208 STATESVILLE RD SUITE 300
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7635
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Country | US
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Telephone | 704-659-9000
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Fax | 704-659-9009
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-03423
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License Number State | NC
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