Provider Demographics
NPI:1649823600
Name:BOWLES, KRISTINA JANE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JANE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E FOREST LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-3921
Mailing Address - Country:US
Mailing Address - Phone:865-406-3825
Mailing Address - Fax:
Practice Address - Street 1:200 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5212
Practice Address - Country:US
Practice Address - Phone:865-835-5880
Practice Address - Fax:865-374-2009
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26289363L00000X
TN204625163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ082833Medicaid