Provider Demographics
NPI:1366826968
Name:BOWIS, KATHRYN JEAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JEAN
Last Name:BOWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:JEAN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:97 THOMAS JOHNSON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4374
Mailing Address - Country:US
Mailing Address - Phone:240-547-6464
Mailing Address - Fax:
Practice Address - Street 1:800 S FREDERICK AVE STE 204
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4152
Practice Address - Country:US
Practice Address - Phone:240-547-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0009884363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2946PAMedicaid
SC2946PAMedicaid