Basic Information
| Provider Information | |||||||||
| NPI: | 1790398469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWDEN | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | LEANNE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 TOWNCENTER BLVD STE 112 | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354061832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054623334 | ||||||||
| FaxNumber: | 2054699586 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TOWNCENTER BLVD STE 112 | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354061832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054623334 | ||||||||
| FaxNumber: | 2054699586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2020 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1-154143 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.