Provider Demographics
NPI:1306656855
Name:BOWMAN, LACY (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2055
Mailing Address - Country:US
Mailing Address - Phone:620-804-6007
Mailing Address - Fax:
Practice Address - Street 1:713 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2055
Practice Address - Country:US
Practice Address - Phone:620-804-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-161411-091163W00000X
KS53-83957-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse