Provider Demographics
NPI:1265056204
Name:BOVELL, KAOLA JAPRIA (CRNP)
Entity type:Individual
Prefix:MS
First Name:KAOLA
Middle Name:JAPRIA
Last Name:BOVELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S TAN ALY STE 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-9349
Mailing Address - Country:US
Mailing Address - Phone:717-865-6644
Mailing Address - Fax:717-865-5666
Practice Address - Street 1:120 S TAN ALY STE 1
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-9349
Practice Address - Country:US
Practice Address - Phone:717-865-6644
Practice Address - Fax:717-865-5666
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN567859163W00000X
PASP022103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse