Provider Demographics
NPI:1699911149
Name:BOWERS, KIMBERLY DIANE (RN,PNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DIANE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:RN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 JOE RAMSEY BLVD E STE 213
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7857
Mailing Address - Country:US
Mailing Address - Phone:903-408-7940
Mailing Address - Fax:903-408-7941
Practice Address - Street 1:4211 JOE RAMSEY BLVD E STE 213
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7857
Practice Address - Country:US
Practice Address - Phone:903-408-7940
Practice Address - Fax:903-408-7941
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666828363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics