Healthcare Provider Details

I. General information

NPI: 1184183006
Provider Name (Legal Business Name): MARY KATHERINE BOWLING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 DAVIS STUART RD
RONCEVERTE WV
24970-9549
US

IV. Provider business mailing address

PO BOX 360
SYLVA NC
28779-0360
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-7546
  • Fax: 304-645-7547
Mailing address:
  • Phone: 888-339-6065
  • Fax: 828-538-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5009957
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: