Provider Demographics
NPI:1972271369
Name:BOWEN, LINDA MARIE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 PINE KNOT PT
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5620
Mailing Address - Country:US
Mailing Address - Phone:662-772-9858
Mailing Address - Fax:
Practice Address - Street 1:6027 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2145
Practice Address - Country:US
Practice Address - Phone:901-226-2800
Practice Address - Fax:901-226-2802
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904562363LA2100X, 363LG0600X, 364SA2200X
TN28635363LA2200X, 363LG0600X
TN0000028635363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health