Provider Demographics
NPI:1902287410
Name:BOWDEN, MISTY (MSW, BSW, CBS)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:MSW, BSW, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-6127
Mailing Address - Country:US
Mailing Address - Phone:432-559-1733
Mailing Address - Fax:
Practice Address - Street 1:4010 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6127
Practice Address - Country:US
Practice Address - Phone:432-559-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174N00000XOther Service ProvidersLactation Consultant, Non-RN