Provider Demographics
NPI:1558728568
Name:BOWEN, KELLY ELISHA R (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ELISHA R
Last Name:BOWEN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:196 NORTH ST
Mailing Address - Street 2:GENEVA GENERAL HOSPITAL, HOSPITALIST DEPT.
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1651
Mailing Address - Country:US
Mailing Address - Phone:315-787-4303
Mailing Address - Fax:315-787-4288
Practice Address - Street 1:196 NORTH ST
Practice Address - Street 2:GENEVA GENERAL HOSPITAL, HOSPITALIST DEPT.
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1651
Practice Address - Country:US
Practice Address - Phone:315-787-4303
Practice Address - Fax:315-787-4288
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF340081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily