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General NPI Number Information
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NPI Number | 1033736525
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Entity Type | Individual
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Provider Name | KATHLEEN JUDGE BOWIE FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 8200 JONES BRANCH DR RM 1317
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City | MC LEAN
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State | VA
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Zip | 22102-3107
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Country | US
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Telephone | 703-903-2844
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Fax |
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Provider Business Mailing Address
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Address Line | 2142 GLENCOURSE LN
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City | RESTON
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State | VA
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Zip | 20191-1315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024179603
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License Number State | VA
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