Provider Demographics
NPI:1487153524
Name:STEPHENS, KRISTY BOWMAN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:BOWMAN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:KRISTY
Other - Middle Name:BOWMAN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-4089
Mailing Address - Fax:814-375-4067
Practice Address - Street 1:145 HOSPITAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1463
Practice Address - Country:US
Practice Address - Phone:814-375-4089
Practice Address - Fax:814-375-4067
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily