Healthcare Provider Details

I. General information

NPI: 1366826968
Provider Name (Legal Business Name): KATHRYN JEAN BOWIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN JEAN WOLF PA-C

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S FREDERICK AVE STE 204
GAITHERSBURG MD
20877-4152
US

IV. Provider business mailing address

97 THOMAS JOHNSON DR STE 200
FREDERICK MD
21702-4374
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-6464
  • Fax:
Mailing address:
  • Phone: 240-547-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0009884
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: