=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205210267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA MARIE BOWERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2015
-----------------------------------------------------
Last Update Date | 11/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 POLER ST
-----------------------------------------------------
City | STARBUCK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56381-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-230-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 E 1ST ST
-----------------------------------------------------
City | MORRIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56267-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-589-1313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP 3983
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------