Provider Demographics
NPI:1053691980
Name:BOWMAN, CARRIE KAY (P-MHNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:KAY
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:P-MHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 E SPEEDWAY BLVD APT 7105
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1544
Mailing Address - Country:US
Mailing Address - Phone:520-721-1887
Mailing Address - Fax:
Practice Address - Street 1:5055 E BROADWAY BLVD STE A200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3649
Practice Address - Country:US
Practice Address - Phone:520-901-4800
Practice Address - Fax:520-318-6979
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID23403A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP5693OtherARIZONA BOARD OF NURSING
AZ944466Medicaid