NPIMap

Organization Active NPI

Bowie State University

  • Adult Health Nurse Practitioner
  • Bowie, MD
National Provider Identifier
1154888048
Registry record updated Feb 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
BOWIE STATE UNIVERSITY
Practice address
14000 Jericho Park Road
Henry Wise Wellness Center, CMRC, Lower Level
Bowie, MD 20715
Phone
(301) 860-4170
Fax
(601) 860-4179
NPI assigned
Feb 27, 2019
Organization subpart
Yes
Parent organization
BOWIE STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2019

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

Authorized official

Name
Dr. Artie Lee Travis, ED.D.
Title
Vice President Student Affairs
Phone
(301) 860-3390

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 202K00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X Primary
Obstetrics & Gynecology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LX0001X

Addresses

Primary practice location

14000 Jericho Park Road
Henry Wise Wellness Center, CMRC, Lower Level
Bowie, MD 20715

Mailing address

14000 Jericho Park Road
Henry Wise Wellness Center, CMRC, Lower Level
Bowie, MD 20715
Phone (301) 860-4170

Other names 1

  • Henry Wise Wellness Center Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D1045748Bowie State University Wellness Center14000 Jericho Park Road CRMC LL, Bowie, MD 20715Provider-performed microscopyDec 4, 2026

National Provider Directory

National Provider Directory
Tax ID family
Howard County Health de83 organizations share this tax ID, including this one
Part of
Amn Healthcare Services Inc

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

14000 Jericho Park Rd
Lowr
Bowie, MD 20715
Phone (301) 860-4170

NPI Registry JSON

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551225600000",
    "number": "1154888048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14000 JERICHO PARK ROAD",
            "address_2": "HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "20715",
            "telephone_number": "301-860-4170",
            "fax_number": "601-860-4179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14000 JERICHO PARK ROAD",
            "address_2": "HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "20715",
            "telephone_number": "301-860-4170",
            "fax_number": "601-860-4179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWIE STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOWIE STATE UNIVERSITY",
        "enumeration_date": "2019-02-27",
        "last_updated": "2019-02-27",
        "status": "A",
        "authorized_official_last_name": "TRAVIS",
        "authorized_official_first_name": "ARTIE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VICE PRESIDENT STUDENT AFFAIRS",
        "authorized_official_telephone_number": "301-860-3390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Wise Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.