1114906401 NPI number — DR. JOYCE FOWLER PH.D.

Table of content: DR. JOYCE FOWLER PH.D. (NPI 1114906401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114906401 NPI number — DR. JOYCE FOWLER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
JOYCE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114906401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 N MCKINLEY ST
Provider Second Line Business Mailing Address:
STE. 500
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-664-6632
Provider Business Mailing Address Fax Number:
501-664-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 N MCKINLEY ST
Provider Second Line Business Practice Location Address:
STE. 500
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-664-6632
Provider Business Practice Location Address Fax Number:
501-664-1441
Provider Enumeration Date:
01/13/2006

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: 103TC0700X , with the licence number:  03-13P , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56230 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 56230 (C979) . This is a "MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".
  • Identifier: Q09887 , issued by the state of ( AR ) . This identifiers is of the category "MEDICARE UPIN".