Provider Demographics
NPI:1518118173
Name:BOWMAN, KELLEY FRANCES (PA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:FRANCES
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:FRANCES
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 410512
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-0512
Mailing Address - Country:US
Mailing Address - Phone:321-727-7992
Mailing Address - Fax:321-727-7664
Practice Address - Street 1:1314 OAK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3111
Practice Address - Country:US
Practice Address - Phone:321-727-7992
Practice Address - Fax:321-727-7664
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical