Provider Demographics
NPI:1013511005
Name:BOWMAN, KATELYN MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2319
Mailing Address - Country:US
Mailing Address - Phone:817-439-9539
Mailing Address - Fax:
Practice Address - Street 1:3107 GREENE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2319
Practice Address - Country:US
Practice Address - Phone:817-439-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily