Jake Bowling
in Myrtle Beach, SC. Individual provider (NPI-1).
NPI number1083174734
StatusActive
Last updated in NPPESAug 6, 2025
Details
- NPI
- 1083174734
- Entity type
- Individual (NPI-1)
- Name
- Jake Bowling
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 20, 2019
- Certification date
- Aug 6, 2025
- Last updated
- Aug 6, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085N0700X | 308958 | NY | Yes | |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
809 82nd PkwyMyrtle Beach, SC 29572-4607
Phone 843-848-4670
Mailing address
102 Trail Bend CtCary, NC 27513-3420
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