Provider Demographics
NPI:1386682862
Name:BOWERS, PAUL KENDELL (FNP-C, DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENDELL
Last Name:BOWERS
Suffix:
Gender:M
Credentials:FNP-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4868
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4868
Mailing Address - Country:US
Mailing Address - Phone:208-232-1000
Mailing Address - Fax:208-232-1006
Practice Address - Street 1:1133 CALL PL STE A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3076
Practice Address - Country:US
Practice Address - Phone:208-232-1000
Practice Address - Fax:208-232-1006
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-901111NS0005X
IDNP-1325A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC1658OtherBLUE CROSS OF IDAHO
ID805681800Medicaid
ID000010027899OtherREGENCE BLUE SHIELD OF ID
ID350052262OtherRAILROAD MEDICARE
ID820530992OtherTAX ID # FOR OTHER INS.
ID820530992OtherTAX ID # FOR OTHER INS.
IDU79188Medicare UPIN