MEDICARE: TERRA BOWEN RN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	166331	OH
2	101YM0800X	Mental Health Counselor
3	171M00000X	Case Manager/Care Coordinator
4	163W00000X	Registered Nurse	420011	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831691591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRA BOWEN RN

Provider Business Mailing Address
First Line	:	PO BOX 402
Second Line	:
City	:	WHEELERSBURG
State	:	OH
Zip	:	45694-0402
Country	:	US
Telephone Number	:	740-858-6683
Fax Number	:

Provider Business Practice Location Address
First Line	:	7175 STATE ROUTE 104
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-8888
Country	:	US
Telephone Number	:	740-858-6683
Fax Number	:

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

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	01/03/2024

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