Provider Demographics
NPI:1033275169
Name:DAVY-BOWLING, KELLY DAWN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DAWN
Last Name:DAVY-BOWLING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HARTZ DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1325
Mailing Address - Country:US
Mailing Address - Phone:513-228-0405
Mailing Address - Fax:
Practice Address - Street 1:44 WARD KOEBEL RD
Practice Address - Street 2:
Practice Address - City:OREGONIA
Practice Address - State:OH
Practice Address - Zip Code:45054-9467
Practice Address - Country:US
Practice Address - Phone:937-289-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.102756164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2659930Medicaid