Basic Information
Provider Information
NPI: 1568960748
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOWLING
FirstName: COURTNEY
MiddleName: REYNOLDS
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1698 OLD LEBANON RD
Address2:  
City: CAMPBELLSVILLE
State: KY
PostalCode: 427189662
CountryCode: US
TelephoneNumber: 2707896175
FaxNumber: 2707896176
Practice Location
Address1: 73 KINGSWOOD DR
Address2:  
City: CAMPBELLSVILLE
State: KY
PostalCode: 42718
CountryCode: US
TelephoneNumber: 2707896175
FaxNumber: 2707893157
Other Information
ProviderEnumerationDate: 01/23/2018
LastUpdateDate: 01/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X3012010KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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