Provider Demographics
NPI:1689067324
Name:BOWENS, KIMAKA
Entity Type:Individual
Prefix:
First Name:KIMAKA
Middle Name:
Last Name:BOWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5629
Mailing Address - Country:US
Mailing Address - Phone:757-473-3969
Mailing Address - Fax:757-506-0157
Practice Address - Street 1:5516 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5629
Practice Address - Country:US
Practice Address - Phone:757-473-3969
Practice Address - Fax:757-506-0157
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185850363L00000X
MSR872000364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health