Provider Demographics
NPI:1114177268
Name:BOWEN, CHRISTOPHER PAUL (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:BOWEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 W BROADWAY STE 810
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2133
Mailing Address - Country:US
Mailing Address - Phone:502-583-0909
Mailing Address - Fax:502-583-0913
Practice Address - Street 1:332 W BROADWAY
Practice Address - Street 2:SUITE #810
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2130
Practice Address - Country:US
Practice Address - Phone:502-583-0909
Practice Address - Fax:502-583-0913
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5577A367500000X
KY3005577367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5577AOtherARNP
KY7100080880Medicaid
KY000000775555OtherBCBS- TROVER FOUNDATION
KYK050720Medicare PIN