Healthcare Provider Details

I. General information

NPI: 1689383705
Provider Name (Legal Business Name): KEETON KELLY BOWER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10513 MARBACH RD STE 102
SAN ANTONIO TX
78245-1995
US

IV. Provider business mailing address

142 MINNESOTA CIR
JACKSONVILLE AR
72076-1127
US

V. Phone/Fax

Practice location:
  • Phone: 210-290-8081
  • Fax:
Mailing address:
  • Phone: 720-900-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1177118
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225947
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: