1982730917 NPI number — ALLISON FIELDS BOWEN APRN

Table of content: KARLIE DOLL IDC (NPI 1518729615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982730917 NPI number — ALLISON FIELDS BOWEN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN
Provider First Name:
ALLISON
Provider Middle Name:
FIELDS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FIELDS
Provider Other First Name:
ALLISON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982730917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 STANLEY GAULT PKWY STE 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-5176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-253-4900
Provider Business Mailing Address Fax Number:
502-489-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 NEW MOODY LN STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-225-5520
Provider Business Practice Location Address Fax Number:
502-225-5522
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3005014 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100022190 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50027831 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50027831 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00755081 . This is a "MEDICARE RR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000512228 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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