MEDICARE: KRISTIN BOWLES ROE L.P.C

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	101YP2500X	Professional Counselor	5233	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	142WN	OTHER	NC	BLUE CROSS BLUE SHIELF

General Provider Information

NPI Number	:	1548349053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN BOWLES ROE L.P.C

Provider Business Mailing Address
First Line	:	2501 BELVEDERE AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3660
Country	:	US
Telephone Number	:	704-780-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	5113 PIPER STATION DR
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6513
Country	:	US
Telephone Number	:	704-541-4242
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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