Healthcare Provider Details

I. General information

NPI: 1710153820
Provider Name (Legal Business Name): KIMBERLY A BOWERS RN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY A. JOHNSON

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64442
BALTIMORE MD
21264-4442
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6196
  • Fax:
Mailing address:
  • Phone: 410-328-6196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberR136148
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: