Healthcare Provider Details

I. General information

NPI: 1972959146
Provider Name (Legal Business Name): KYLE HARVE BOWMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-5066
  • Fax:
Mailing address:
  • Phone: 614-293-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019720
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.382328
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: