Individual
CASEY RAE BOWLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4615 HUNTRIDGE RD, ROANOKE, VA 24012-8510
(540) 977-0900
(540) 977-0550
Mailing address
4615 HUNTRIDGE RD, ROANOKE, VA 24012-8510
(540) 977-0900
(540) 977-0550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004997
VA
363AM0700X
Medical Physician Assistant
0110004997
VA
363AS0400X
Surgical Physician Assistant
0110004997
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962885020
—
VA
Enumeration date
07/07/2015
Last updated
05/02/2017
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