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General NPI Number Information
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NPI Number | 1841154655
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Entity Type | Individual
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Provider Name | JACOB BOWLES PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 159 HARTLEY WAY
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City | PEARISBURG
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State | VA
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Zip | 24134-2471
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Country | US
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Telephone | 540-921-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 18720 OLD HOMESTEAD WAY
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City | ABINGDON
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State | VA
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Zip | 24211-6692
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Country | US
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Telephone | 276-698-9549
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110011533
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License Number State | VA
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