Tiffany Allison Bowen, NNP, PNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R855554 Issued in MS

Practice address

321 E Fifteenth St
Yazoo City, MS 39194-2631

Phone

(662) 532-1543

Fax

(662) 532-1544

NPI assigned

Jul 19, 2006

Last updated

Oct 4, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Tiffany Wingate Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

State licenses

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Kidz 1St Clinic, LLC

  • Rural Health Clinic/Center
  • Yazoo City, MS
  • NPI 1083265284

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kidz 1St Clinic, LLC

  • Rural Health Clinic/Center
  • Yazoo City, MS
  • NPI 1083265284
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1073533782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 E FIFTEENTH ST",
            "city": "YAZOO CITY",
            "state": "MS",
            "postal_code": "391942631",
            "telephone_number": "662-532-1543",
            "fax_number": "662-532-1544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 E FIFTEENTH ST",
            "city": "YAZOO CITY",
            "state": "MS",
            "postal_code": "391942631",
            "telephone_number": "662-532-1543",
            "fax_number": "662-532-1544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 River Bend Place",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Flowood",
            "state": "MS",
            "postal_code": "39232",
            "country_code": "US",
            "telephone_number": "601-957-7345",
            "fax_number": "769-251-5429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOWEN",
        "first_name": "TIFFANY",
        "middle_name": "ALLISON",
        "credential": "NNP, PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R855554",
            "primary": true
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "MS",
            "license": "R855554",
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "MS",
            "license": "R855554",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MS",
            "license": "R855554",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001003099",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "WINGATE",
            "credential": "NNP, PNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Kathryn Brooks
• Vera R Brooks, M.D.
• Aslean Brown
• Cynthia Lee Brown, PT

• Nurse Practitioner in Yazoo City, MS
• Providers in Yazoo City, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.