Provider Demographics
NPI:1184150278
Name:BOWEN, KATRINA LOUISE (PA)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LOUISE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:LOUISE
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-629-1504
Mailing Address - Fax:360-629-1513
Practice Address - Street 1:7205 265TH ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6221
Practice Address - Country:US
Practice Address - Phone:360-629-1504
Practice Address - Fax:360-629-1513
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60762680363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60762680OtherWA STATE LICENSE NUMBER