MEDICARE: KRISTIN BOWMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1003009887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN BOWMAN

Provider Business Mailing Address
First Line	:	111 NATURE WALK PKWY
Second Line	:	SUITE 101
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-5073
Country	:	US
Telephone Number	:	904-230-7761
Fax Number	:	904-230-7763

Provider Business Practice Location Address
First Line	:	111 NATURE WALK PKWY
Second Line	:	SUITE 101
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-5073
Country	:	US
Telephone Number	:	904-230-7761
Fax Number	:	904-230-7763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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Directions to “ KRISTIN BOWMAN ” Practice Location

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