Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 9960 | WI |
N | 363LA2100X | Nurse Practitioner - Acute Care | AP132567 | TX |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 200458 | OK |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | MED-APRN-REG-0001701 | MT |
NPI | 1386180354 |
---|---|
Provider Name | Kelly Bowman |
First Address | Oklahoma City, OK 73126-0901 |
Second Address | Oklahoma City, OK 73117-1039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2017 |
Last Update Date | 14/12/2021 |