MEDICARE: KELLY BOWMAN MSN, APRN, AGACNP-BC

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	363LC0200X	Critical Care Medicine Nurse Practitioner	MED-APRN-REG-0001701	MT
2	363LA2100X	Acute Care Nurse Practitioner	AP132567	TX
3	363L00000X	Nurse Practitioner	71017897A	IN
4	363LC0200X	Critical Care Medicine Nurse Practitioner	200458	OK

General Provider Information

NPI Number	:	1386180354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BOWMAN MSN, APRN, AGACNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 26901
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-0901
Country	:	US
Telephone Number	:	405-271-4351
Fax Number	:	405-271-8695

Provider Business Practice Location Address
First Line	:	1122 NE 13TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-4351
Fax Number	:	405-271-8695

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

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	04/12/2026

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