=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265482145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANETTE L. BOWLES M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3215 N. NORTH HILLS BLVD.
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-463-7102
-----------------------------------------------------
Fax | 479-463-7864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 EAST APPLEBY ROAD SUITE 102
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-463-7102
-----------------------------------------------------
Fax | 479-463-7864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | E4637
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | E-4637
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------