| Bowsers Garden Llc | |
|
2400 W Dunlap Ave Ste 125 Phoenix AZ 85021-2885 | |
| (520) 340-8686 | |
| (623) 738-4025 |
| Full Name | Bowsers Garden Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2400 W Dunlap Ave Ste 125, Phoenix, Arizona |
| Authorized Official Name and Position | Luanne Takacs Kelly (CEO, DNP) |
| Authorized Official Contact | 6026987597 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bowsers Garden Llc 2400 W Dunlap Ave Ste 125 Phoenix AZ 85021-2885 Ph: (602) 698-7597 | Bowsers Garden Llc 2400 W Dunlap Ave Ste 125 Phoenix AZ 85021-2885 Ph: (520) 340-8686 |
| NPI Number | 1205476868 |
|---|---|
| Provider Enumeration Date | 01/13/2020 |
| Last Update Date | 06/05/2025 |
| Medicare PECOS PAC ID | 8820419690 |
|---|---|
| Medicare Enrollment ID | O20200603000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205476868 | NPI | - | NPPES |
| 616876 | Medicaid | AZ | |
| 1073849360 | Other | AZ | INDIVIDUAL NP |
| 048119 | Other | ANCC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | (* (Not Available)) | Primary |
| Provider Name | Luanne T Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073849360 PECOS PAC ID: 6608906961 Enrollment ID: I20110909002633 |
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