Provider Demographics
NPI:1295157196
Name:BOWERS, KATHLEEN L (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:L
Last Name:BOWERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3909
Mailing Address - Country:US
Mailing Address - Phone:423-892-2221
Mailing Address - Fax:423-490-3407
Practice Address - Street 1:961 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3909
Practice Address - Country:US
Practice Address - Phone:423-892-2221
Practice Address - Fax:423-490-3407
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16964363LF0000X
GARN216536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1035I02619Medicare UPIN