Provider Demographics
NPI:1326278516
Name:BOWEN, KATHLEEN A (NPP-PC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:BOWEN
Suffix:
Gender:F
Credentials:NPP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3771 NESCONSET HWY STE 212
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1154
Mailing Address - Country:US
Mailing Address - Phone:631-689-5433
Mailing Address - Fax:631-883-6652
Practice Address - Street 1:3771 NESCONSET HWY STE 212
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1154
Practice Address - Country:US
Practice Address - Phone:631-689-5433
Practice Address - Fax:631-883-6652
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401202363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health