Provider Demographics
NPI:1447844014
Name:BOWLING GREEN NEUROLOGY AND PRIMARY CARE LLC
Entity type:Organization
Organization Name:BOWLING GREEN NEUROLOGY AND PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-393-8418
Mailing Address - Street 1:523 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1765
Mailing Address - Country:US
Mailing Address - Phone:270-393-8418
Mailing Address - Fax:270-393-8440
Practice Address - Street 1:523 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1765
Practice Address - Country:US
Practice Address - Phone:270-393-8418
Practice Address - Fax:270-393-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty