Healthcare Provider Details

I. General information

NPI: 1326734393
Provider Name (Legal Business Name): CAMRYN JOAN GOWAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10216 TAYLORSVILLE RD STE 400
LOUISVILLE KY
40299-3616
US

IV. Provider business mailing address

1901 CAMPUS PL
LOUISVILLE KY
40299-2308
US

V. Phone/Fax

Practice location:
  • Phone: 502-267-5456
  • Fax: 502-267-5488
Mailing address:
  • Phone: 502-253-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61919
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: