Provider Demographics
NPI:1871795542
Name:JIMMY W BOWLIN JR CRNP LLC
Entity type:Organization
Organization Name:JIMMY W BOWLIN JR CRNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSR PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-458-3486
Mailing Address - Street 1:581 CANOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-8971
Mailing Address - Country:US
Mailing Address - Phone:256-458-3486
Mailing Address - Fax:
Practice Address - Street 1:581 CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-8971
Practice Address - Country:US
Practice Address - Phone:256-458-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-056721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS73577Medicare UPIN