Healthcare Provider Details

I. General information

NPI: 1952870768
Provider Name (Legal Business Name): KENZIE DANIELLE BOWLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 HARRY HINES BLVD
DALLAS TX
75390-3417
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-7208
US

V. Phone/Fax

Practice location:
  • Phone: 214-633-5555
  • Fax: 214-645-6757
Mailing address:
  • Phone: 210-862-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12543
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: