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Contact Information

KENDRA D BOWEN, PAC
1441 W BROADWAY
CENTRALIA, IL62801-5613
 Phone: 618-532-9050
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KENDRA D BOWEN · (Female)

NPI Number 1457318438
Status Active
Credentials PAC
Entity Individual
Enumeration date 04/26/2006
Last updated 11/12/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 085003158
  • NY License # 010234
  • IL Other 207988 MED GROUP #
  • IL Other 208959 MED GRP #
  • IL Other CE9335 RR GROUP #
  • IL Other P00469189 RR MEDICARE PTAN
Hospital affiliation(s)
  • GOOD SAMARITAN REGIONAL HEALTH CENTER - (Acute Care)
    1 GOOD SAMARITAN WAY
    MOUNT VERNON, IL 62864
  • ST MARYS HOSPITAL - (Acute Care)
    400 NORTH PLEASANT AVENUE
    CENTRALIA, IL 62801
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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