Provider Demographics
NPI:1104824358
Name:BOWERMAN, KAREN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:BOWERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 TRAVIS CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-4481
Mailing Address - Country:US
Mailing Address - Phone:540-533-4757
Mailing Address - Fax:
Practice Address - Street 1:DRY RUN RD
Practice Address - Street 2:CITY HOSPITAL
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-264-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001519363A00000X
WV1106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
BOPA24541Medicare ID - Type Unspecified
WVP63845Medicare UPIN