Provider Demographics
NPI:1861958522
Name:BOWEN, SAMANTHA LYNN (FNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:FNP
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 986
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0986
Mailing Address - Country:US
Mailing Address - Phone:919-693-6541
Mailing Address - Fax:919-693-7396
Practice Address - Street 1:110 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2576
Practice Address - Country:US
Practice Address - Phone:919-693-6541
Practice Address - Fax:919-693-7396
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2024-02-17
Deactivation Date:2019-02-18
Deactivation Code:
Reactivation Date:2019-02-27
Provider Licenses
StateLicense IDTaxonomies
NC5011479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily