Healthcare Provider Details

I. General information

NPI: 1699911149
Provider Name (Legal Business Name): KIMBERLY DIANE BOWERS RN,PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 JOE RAMSEY BLVD E STE 213
GREENVILLE TX
75401-7857
US

IV. Provider business mailing address

4211 JOE RAMSEY BLVD E STE 213
GREENVILLE TX
75401-7857
US

V. Phone/Fax

Practice location:
  • Phone: 903-408-7940
  • Fax: 903-408-7941
Mailing address:
  • Phone: 903-408-7940
  • Fax: 903-408-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number666828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: