Provider Demographics
NPI:1245118678
Name:BOWLEY, KELLY VIKTORIN (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:VIKTORIN
Last Name:BOWLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 POPLAR AVE
Mailing Address - Street 2:KJANSKYRN@GMAIL.COM
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-9961
Mailing Address - Country:US
Mailing Address - Phone:281-467-2573
Mailing Address - Fax:
Practice Address - Street 1:410 POPLAR AVE
Practice Address - Street 2:KJANSKYRN@GMAIL.COM
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-9961
Practice Address - Country:US
Practice Address - Phone:281-467-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689023163WI0500X
171400000X
AK243998163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No171400000XOther Service ProvidersHealth & Wellness Coach