MEDICARE: ANTHONY TYLER BOWEN MS, RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1432	WV

General Provider Information

NPI Number	:	1376377291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY TYLER BOWEN MS, RDN, LD

Provider Business Mailing Address
First Line	:	4534 MAGAZINE AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25704-1020
Country	:	US
Telephone Number	:	681-888-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	4534 MAGAZINE AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25704-1020
Country	:	US
Telephone Number	:	681-888-1365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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