Provider Demographics
NPI:1366826968
Name:BOWIS, KATHRYN JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JEAN
Last Name:BOWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:JEAN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:
Practice Address - Street 1:300 CALLEN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2816
Practice Address - Country:US
Practice Address - Phone:843-723-8823
Practice Address - Fax:843-606-8059
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2946PAMedicaid
SC2946PAMedicaid