Provider Demographics
NPI:1063734671
Name:JIMMY W BOWLIN JR CRNP LLC
Entity type:Organization
Organization Name:JIMMY W BOWLIN JR CRNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:256-458-3486
Mailing Address - Street 1:137 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:AL
Mailing Address - Zip Code:35905-9603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 HICKORY RIDGE DR
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:AL
Practice Address - Zip Code:35905-9603
Practice Address - Country:US
Practice Address - Phone:256-442-5937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty