MEDICARE: KEVIN BOWER FNP, BSN, RN, ATC

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	2255A2300X	Athletic Trainer	2000032842	CA
2	363LF0000X	Family Nurse Practitioner	95038201	CA
3	163W00000X	Registered Nurse	95314951	CA

General Provider Information

NPI Number	:	1215387444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN BOWER FNP, BSN, RN, ATC

Provider Business Mailing Address
First Line	:	1318 N LAS PALMAS AVE APT 9
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7691
Country	:	US
Telephone Number	:	707-843-9607
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 W ADAMS BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2664
Country	:	US
Telephone Number	:	213-742-1000
Fax Number	:

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

Provider Enumeration Date	:	06/19/2016
Last Update Date	:	05/29/2026

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