Provider Demographics
NPI:1740574011
Name:BOWMAN, ROXANNE KATRINA (CPNP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:KATRINA
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 RED MILE PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1172
Mailing Address - Country:US
Mailing Address - Phone:859-218-2273
Mailing Address - Fax:
Practice Address - Street 1:1135 RED MILE PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1172
Practice Address - Country:US
Practice Address - Phone:859-218-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004386363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012549Medicaid