Provider Demographics
NPI:1356489124
Name:BOWMAN, KATHRYN SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SUE
Last Name:BOWMAN
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 1:110 EZEE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3847
Mailing Address - Country:US
Mailing Address - Phone:423-543-4420
Mailing Address - Fax:
Practice Address - Street 1:403 E G ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3223
Practice Address - Country:US
Practice Address - Phone:423-543-2521
Practice Address - Fax:423-543-7348
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN030461163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health