Provider Demographics
NPI:1215387444
Name:BOWER, KEVIN (BSN, RN, ATC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BOWER
Suffix:
Gender:M
Credentials:BSN, RN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 N LAS PALMAS AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7691
Mailing Address - Country:US
Mailing Address - Phone:707-843-9607
Mailing Address - Fax:
Practice Address - Street 1:139 MEADOW PL
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9666
Practice Address - Country:US
Practice Address - Phone:707-843-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000328422255A2300X
390200000X
CA95314951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program