Healthcare Provider Details

I. General information

NPI: 1518387992
Provider Name (Legal Business Name): KENZIE JANE BOWEN JOHNSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KENZIE JANE BOWEN M.D.

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ERWIN RD
DURHAM NC
27705-3941
US

IV. Provider business mailing address

3433 DOVER RD
DURHAM NC
27707-4554
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-6721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017-01613
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2017-01613
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: