Bowman, Jeta Laurie

Bowman, Jeta Laurie is an individual health care provider with primary practice located at 520 Douglas Blvd , Tyler TX 75702. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Bowman, Jeta Laurie can be contacted via phone (903) 606-1721.

Contact Information

Primary practice address
520 Douglas Blvd Tyler TX 75702
Phone: (903) 606-1721
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X AP130960 Texas
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X AP130960 Texas

Profile Details

NPI number 1366899288
LBN Legal business name Bowman, Jeta Laurie
Credentials AGNP
Entity Individual
Sole proprietor 1 No
Enumeration date May 20th, 2016
Last updated Jul 1st, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366899288 NPPES
Texas MEDICAID 381618302
Texas Other P02223408
Texas Other 787876

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