Provider Demographics
NPI:1588272116
Name:BOWDEN, KRISTINA JANE NYE (PA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JANE NYE
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1452 BENCH RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2402
Mailing Address - Country:US
Mailing Address - Phone:208-320-6450
Mailing Address - Fax:
Practice Address - Street 1:738 N COLLEGE RD STE A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3386
Practice Address - Country:US
Practice Address - Phone:208-814-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant