Provider Demographics
NPI:1366268930
Name:BOWERS, CHARLES (PA-S)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7044 GRANDEUR PL APT 156
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-8231
Mailing Address - Country:US
Mailing Address - Phone:417-429-8608
Mailing Address - Fax:
Practice Address - Street 1:410 MEIJER DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5128
Practice Address - Country:US
Practice Address - Phone:800-343-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-28
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARPA-1383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program