Provider Demographics
NPI:1740471960
Name:BOWMAN, KENNY LANE (DO)
Entity type:Individual
Prefix:DR
First Name:KENNY
Middle Name:LANE
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-8700
Mailing Address - Country:US
Mailing Address - Phone:606-432-2213
Mailing Address - Fax:
Practice Address - Street 1:2710 N STEMMONS FWY (MAXIM PHYSICIAN RESOURCES)
Practice Address - Street 2:SUITE 100, NORTH TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2210
Practice Address - Country:US
Practice Address - Phone:888-800-1853
Practice Address - Fax:214-741-0701
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03047207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100044960Medicaid
KY7100044960Medicaid