Provider Demographics
NPI:1922058353
Name:BOWEN, DEANNA KIM (NP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KIM
Last Name:BOWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N BUCKNER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3498
Mailing Address - Country:US
Mailing Address - Phone:214-660-2020
Mailing Address - Fax:214-660-2017
Practice Address - Street 1:1110 N BUCKNER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3498
Practice Address - Country:US
Practice Address - Phone:214-660-2020
Practice Address - Fax:214-660-2017
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501464363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166253803Medicaid
TX166253804Medicaid
NP7208OtherBLUE CROSS BLUE SHIELD
TX166253805Medicaid
TX8D1879Medicare PIN
TX166253803Medicaid
TX8K2858Medicare PIN
NP7208OtherBLUE CROSS BLUE SHIELD