| Kelly Jo Bowles Pllc | |
|
104 Treemonte Dr Orange City FL 32763-7953 | |
| (386) 385-4748 | |
| Not Available |
| Full Name | Kelly Jo Bowles Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 104 Treemonte Dr, Orange City, Florida |
| Authorized Official Name and Position | Kelly Bowles (OWNER/LCSW) |
| Authorized Official Contact | 4073246242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Jo Bowles Pllc 2578 Enterprise Rd # 171 Orange City FL 32763-7904 Ph: (386) 385-4748 | Kelly Jo Bowles Pllc 104 Treemonte Dr Orange City FL 32763-7953 Ph: (386) 385-4748 |
| NPI Number | 1710453998 |
|---|---|
| Provider Enumeration Date | 10/16/2018 |
| Last Update Date | 02/21/2021 |
| Certification Date | 02/18/2021 |
| Medicare PECOS PAC ID | 9830433283 |
|---|---|
| Medicare Enrollment ID | O20181212000267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710453998 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kelly Bowles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093259194 PECOS PAC ID: 9638451495 Enrollment ID: I20170131002085 |
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