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General NPI Number Information
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NPI Number | 1760246433
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Entity Type | Individual
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Provider Name | JACQUELINE BOWSER-KNIGHT
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Gender | Female
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 805 LIVE OAK DR STE 103
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2672
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Country | US
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Telephone | 757-943-6264
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Fax |
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Provider Business Mailing Address
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Address Line | 4742 BRIANS WAY
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City | CHESAPEAKE
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State | VA
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Zip | 23321-4489
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Country | US
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Telephone | 757-943-6264
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1236001353
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License Number State | VA
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