Provider Demographics
NPI:1437039658
Name:BOWERY, CARISSA RENEE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:RENEE
Last Name:BOWERY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 RIDGE PARKE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2035
Mailing Address - Country:US
Mailing Address - Phone:423-930-5040
Mailing Address - Fax:
Practice Address - Street 1:1181 RIDGE PARKE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2035
Practice Address - Country:US
Practice Address - Phone:423-930-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine