1023279189 NPI number — MRS. TRACEY L FOWL MASTERS IN SPED

Table of content: MRS. TRACEY L FOWL MASTERS IN SPED (NPI 1023279189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023279189 NPI number — MRS. TRACEY L FOWL MASTERS IN SPED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWL
Provider First Name:
TRACEY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTERS IN SPED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WYATT
Provider Other First Name:
TRACEY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023279189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 HOLIDAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42701-6490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-823-7075
Provider Business Mailing Address Fax Number:
270-360-3271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 HOLIDAY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-6490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-823-7075
Provider Business Practice Location Address Fax Number:
270-360-3271
Provider Enumeration Date:
06/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X , with the licence number:  EPSB ID: 71846 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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