Provider Demographics
NPI:1770611311
Name:BOWEN, AMY KRISTINA (ACNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KRISTINA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:GILDEN
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6654
Practice Address - Fax:864-560-7353
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2112363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC21668510OtherMEDICARE PIN
SCNP1307Medicaid
SCSC21669068OtherMEDICARE PIN
SCSC21665019OtherMEDICARE PIN