Provider Demographics
NPI:1427162981
Name:BOWEN, KATHLEEN A (FNPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:BOWEN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:GRIMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:1012 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-945-5247
Practice Address - Fax:207-990-1248
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81796363L00000X
MEAP081796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432340099Medicaid
MEAP081796OtherAPRN
MEAP081796OtherAPRN
ME432340099Medicaid
MB145433OtherDEA
MEAP081796OtherAPRN