Healthcare Provider Details

I. General information

NPI: 1992735013
Provider Name (Legal Business Name): KAREN ELINA BOWEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 BROAD ST
KERNERSVILLE NC
27284-2932
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-993-8181
  • Fax: 336-996-9539
Mailing address:
  • Phone: 336-993-8181
  • Fax: 336-996-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200501101
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number2005-01101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: