Provider Demographics
NPI:1063076479
Name:BOWMAN, KELLIE L
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 G ST SE APT 11
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5069
Mailing Address - Country:US
Mailing Address - Phone:202-848-0154
Mailing Address - Fax:
Practice Address - Street 1:3328 6TH ST SE APT T1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3818
Practice Address - Country:US
Practice Address - Phone:202-883-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant