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General NPI Number Information
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NPI Number | 1942587332
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Entity Type | Organization
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Legal Business Name | COASTAL FAMILY MEDICINE AND WELLNESS CENTER,PLLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 5200 NORTH CROATAN HIGHWAY SUITE 7
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City | KITTY HAWK
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State | NC
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Zip | 27949
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Country | US
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Telephone | 252-715-0607
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Fax |
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 228
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City | KITTY HAWK
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State | NC
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Zip | 27949
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Country | US
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Telephone | 252-715-0607
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHRISTINA MICHELLE BOWEN
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Credential | M.D.
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Telephone | 252-489-3599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2008-00943
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License Number State | NC
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