Provider Demographics
NPI:1861099269
Name:BOWLING GREEN PSYCHIATRY
Entity type:Organization
Organization Name:BOWLING GREEN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DALTREY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TYREE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-421-3397
Mailing Address - Street 1:730 FAIRVIEW AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2365
Mailing Address - Country:US
Mailing Address - Phone:270-715-0665
Mailing Address - Fax:270-550-2008
Practice Address - Street 1:730 FAIRVIEW AVE STE B3
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2365
Practice Address - Country:US
Practice Address - Phone:270-715-0665
Practice Address - Fax:270-550-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100697650Medicaid