Provider Demographics
NPI:1124758826
Name:BOWDRY, MONYE
Entity type:Individual
Prefix:
First Name:MONYE
Middle Name:
Last Name:BOWDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-9301
Mailing Address - Country:US
Mailing Address - Phone:662-840-6366
Mailing Address - Fax:662-680-9797
Practice Address - Street 1:128 PAULS DR
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-8296
Practice Address - Country:US
Practice Address - Phone:662-231-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM7179104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker