MEDICARE: KENZIE DANIELLE BOWLEY PA-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	363A00000X	Physician Assistant	PA12543	TX

General Provider Information

NPI Number	:	1952870768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENZIE DANIELLE BOWLEY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:	210-862-6731
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-3417
Country	:	US
Telephone Number	:	214-633-5555
Fax Number	:	214-645-6757

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

Provider Enumeration Date	:	11/21/2018
Last Update Date	:	12/09/2025

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Directions to “ KENZIE DANIELLE BOWLEY PA-C” Practice Location

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