MEDICARE: KELLY JO BOWLES PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1710453998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY JO BOWLES PLLC

Provider Business Mailing Address
First Line	:	14803 FOREST RD, #139
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-9005
Country	:	US
Telephone Number	:	386-385-4748
Fax Number	:

Provider Business Practice Location Address
First Line	:	14803 FOREST RD, #139
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-9005
Country	:	US
Telephone Number	:	386-385-4748
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LCSW
Name	:	KELLY BOWLES
Credential	:
Telephone Number	:	407-324-6242

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	02/02/2026

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