Provider Demographics
NPI:1134884356
Name:OWENS, BAYO IVYL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BAYO
Middle Name:IVYL
Last Name:OWENS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 RICHFISH RUN DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1988
Mailing Address - Country:US
Mailing Address - Phone:832-258-0772
Mailing Address - Fax:
Practice Address - Street 1:410 RICHFISH RUN DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-1988
Practice Address - Country:US
Practice Address - Phone:832-258-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058783363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health