MEDICARE: MRS. BEVERLY LUCINDA BOWLING NP

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	363LA2200X	Adult Health Nurse Practitioner	3007778	KY

General Provider Information

NPI Number	:	1609110352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY LUCINDA BOWLING NP

Provider Business Mailing Address
First Line	:	PO BOX 72700
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-0700
Country	:	US
Telephone Number	:	502-380-5503
Fax Number	:	502-937-3807

Provider Business Practice Location Address
First Line	:	3625 FERN VALLEY RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1916
Country	:	US
Telephone Number	:	502-964-3381
Fax Number	:

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

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/19/2012

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