Healthcare Provider Details

I. General information

NPI: 1023164381
Provider Name (Legal Business Name): KIMBERLY ANN BOYD-BOWMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W CECIL AVE
DELANO CA
93215-1821
US

IV. Provider business mailing address

531 N HELENE ST
TULARE CA
93274-3127
US

V. Phone/Fax

Practice location:
  • Phone: 661-458-6112
  • Fax:
Mailing address:
  • Phone: 919-802-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30712
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30712
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2468
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number30712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: