Provider Demographics
NPI:1346947371
Name:BOWLES, KELLY ROBERTS
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ROBERTS
Last Name:BOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1151
Mailing Address - Country:US
Mailing Address - Phone:205-718-6458
Mailing Address - Fax:
Practice Address - Street 1:309 BRENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1151
Practice Address - Country:US
Practice Address - Phone:205-718-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool