Basic Information
| Provider Information | |||||||||
| NPI: | 1558733915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWE | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 GARDINER VIEW AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402131877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024560494 | ||||||||
| FaxNumber: | 5024560496 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 GARDINER VIEW AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402131877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024560494 | ||||||||
| FaxNumber: | 5024560496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2015 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3009834 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 3009834 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.