Provider Demographics
NPI:1023626736
Name:BOWLEN, REAGAN
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:BOWLEN
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 1:244 ANKROM RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:PA
Mailing Address - Zip Code:15344-4055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2057 PA-130
Practice Address - Street 2:
Practice Address - City:JEANETTE
Practice Address - State:PA
Practice Address - Zip Code:15644
Practice Address - Country:US
Practice Address - Phone:724-527-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant