MEDICARE: C 2 K HEALTH AND WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1306392311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C 2 K HEALTH AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	2510 S LOOP 336 W STE 115
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3737
Country	:	US
Telephone Number	:	936-235-2825
Fax Number	:	936-235-2826

Provider Business Practice Location Address
First Line	:	2510 S LOOP 336 W STE 115
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3737
Country	:	US
Telephone Number	:	936-235-2825
Fax Number	:	936-235-2826

Authorized Official
Title or Position	:	OWNER
Name	:	CONNIE BOWLIN
Credential	:	NP
Telephone Number	:	936-235-2825

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/11/2022

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