Provider Demographics
NPI:1316529704
Name:BOWEN, KRISTEN CAROLINE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CAROLINE
Last Name:BOWEN
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:LOMA LINDA UNIVERSITY 11262 CAMPUS STREET- WEST HALL
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-1000
Mailing Address - Fax:
Practice Address - Street 1:6033 BROADWAY BLVD SUITE C
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043
Practice Address - Country:US
Practice Address - Phone:972-626-1234
Practice Address - Fax:972-686-9000
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1151512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program