Healthcare Provider Details

I. General information

NPI: 1154386761
Provider Name (Legal Business Name): ELIZABETH L BOWERS-KLAINE WCHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

301 FISHER ST
BILOXI MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-6512
  • Fax: 228-377-7402
Mailing address:
  • Phone: 228-377-6512
  • Fax: 228-376-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number420461-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: