Provider Demographics
NPI:1942587332
Name:COASTAL FAMILY MEDICINE AND WELLNESS CENTER,PLLC
Entity Type:Organization
Organization Name:COASTAL FAMILY MEDICINE AND WELLNESS CENTER,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-489-3599
Mailing Address - Street 1:POST OFFICE BOX 228
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949
Mailing Address - Country:US
Mailing Address - Phone:252-715-0607
Mailing Address - Fax:
Practice Address - Street 1:5200 NORTH CROATAN HIGHWAY
Practice Address - Street 2:SUITE 7
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949
Practice Address - Country:US
Practice Address - Phone:252-715-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty