Healthcare Provider Details

I. General information

NPI: 1215387444
Provider Name (Legal Business Name): KEVIN BOWER FNP, BSN, RN, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W ADAMS BLVD
LOS ANGELES CA
90007-2664
US

IV. Provider business mailing address

1318 N LAS PALMAS AVE APT 9
LOS ANGELES CA
90028-7691
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-1000
  • Fax:
Mailing address:
  • Phone: 707-843-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038201
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95314951
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000032842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: