Provider Demographics
NPI:1669003273
Name:BOWMAN, KEITH (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1225
Mailing Address - Country:US
Mailing Address - Phone:248-894-1999
Mailing Address - Fax:
Practice Address - Street 1:2112 PINECREST DR
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1225
Practice Address - Country:US
Practice Address - Phone:248-894-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026805363L00000X
MI4704288263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily