Provider Demographics
NPI:1497100390
Name:BHOWMIK, KANCHAN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KANCHAN
Middle Name:
Last Name:BHOWMIK
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 REEVES DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-9644
Mailing Address - Country:US
Mailing Address - Phone:970-227-0894
Mailing Address - Fax:
Practice Address - Street 1:4770 LARIMER PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-8912
Practice Address - Country:US
Practice Address - Phone:970-461-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1621971163W00000X
COAPN.0995127-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse