Provider Demographics
NPI:1992923783
Name:BOWMAN, KRISTIN DAVEEN (DO)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DAVEEN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 HEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4232
Mailing Address - Country:US
Mailing Address - Phone:304-881-1040
Mailing Address - Fax:
Practice Address - Street 1:122 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2352
Practice Address - Country:US
Practice Address - Phone:304-487-7726
Practice Address - Fax:304-431-5283
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2291207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine