Provider Demographics
NPI:1114766219
Name:BOWDEN, JEANNISA J (PHD, ND, BCHP, CJT)
Entity type:Individual
Prefix:MRS
First Name:JEANNISA
Middle Name:J
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:PHD, ND, BCHP, CJT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371
Mailing Address - Country:US
Mailing Address - Phone:910-220-8030
Mailing Address - Fax:
Practice Address - Street 1:1030 SEVEN LAKES DRIVE
Practice Address - Street 2:UNIT E
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:910-220-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath