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NPI Code Detail

MEDICARE: KELLIE LYNN BOWHALL LPN

MEDICARE: KELLIE LYNN BOWHALL LPN
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
1164W00000XLicensed Practical Nurse55304SC
2164W00000XLicensed Practical Nurse277760NY

General Provider Information

NPI Number : 1649598749
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE LYNN BOWHALL LPN
Provider Business Mailing Address
First Line : 34048 ANTWERP ST
Second Line :
City : PHILADELPHIA
State : NY
Zip : 13673-4106
Country : US
Telephone Number : 843-704-6110
Fax Number :
Provider Business Practice Location Address
First Line : 650 STATE ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2839
Country : US
Telephone Number : 315-755-1251
Fax Number : 315-291-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2010
Last Update Date : 09/11/2024

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