Basic Information
Provider Information
NPI: 1184183006
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOWLING
FirstName: MARY
MiddleName: KATHERINE
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 360
Address2:  
City: SYLVA
State: NC
PostalCode: 287790360
CountryCode: US
TelephoneNumber: 8883396065
FaxNumber: 8285384441
Practice Location
Address1: 103 DAVIS STUART RD
Address2:  
City: RONCEVERTE
State: WV
PostalCode: 249709549
CountryCode: US
TelephoneNumber: 3046457546
FaxNumber: 3046457547
Other Information
ProviderEnumerationDate: 03/19/2019
LastUpdateDate: 03/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X5009957NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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