Provider Demographics
NPI:1053186478
Name:BOWERS, TABITHA DAWN
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:DAWN
Last Name:BOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-3328
Mailing Address - Country:US
Mailing Address - Phone:940-217-8936
Mailing Address - Fax:
Practice Address - Street 1:712 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6510
Practice Address - Country:US
Practice Address - Phone:940-217-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator