Healthcare Provider Details

I. General information

NPI: 1184528143
Provider Name (Legal Business Name): KATELYN BOWMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HOLSTON DR
GREENEVILLE TN
37743-3126
US

IV. Provider business mailing address

108 JOHNSON ST APT 4
GREENEVILLE TN
37745-6361
US

V. Phone/Fax

Practice location:
  • Phone: 423-638-4171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9689
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: