Individual
TONI HICKS BOWYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
98 WILLOW LN, SPARTANBURG, SC 29307-1357
(864) 585-5552
(864) 597-0179
Mailing address
DEPT. 453 PO 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-00456
NC
363A00000X
Physician Assistant
Primary
PA1068
SC
363AM0700X
Medical Physician Assistant
0010-00456
NC
363AM0700X
Medical Physician Assistant
1068
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0470PA
—
SC
05
—
1003847286
—
NC
01
—
NNK275A
MEDICARE PTAN
NC
01
—
SCM2214292
MEDICARE PTAN
SC
Enumeration date
07/05/2006
Last updated
10/31/2023
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