Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | R855554 | MS |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R855554 | MS |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R855554 | MS |
NPI | 1073533782 |
---|---|
Provider Name | Tiffany Allison Bowen |
First Address | Yazoo City, MS 39194-2631 |
Second Address | Yazoo City, MS 39194-2631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 11/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01003099 | (05) | MS |