1215767801 NPI number — KELLI FOWLER MEADOWS AGACNP, FNP

Table of content: KELLI FOWLER MEADOWS AGACNP, FNP (NPI 1215767801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215767801 NPI number — KELLI FOWLER MEADOWS AGACNP, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEADOWS
Provider First Name:
KELLI
Provider Middle Name:
FOWLER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGACNP, FNP
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:
1215767801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 HARDY ST
Provider Second Line Business Mailing Address:
ATTN: KARLA WILSON, ADMINISTRATION
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39402-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-268-8103
Provider Business Mailing Address Fax Number:
601-268-5008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5003 HARDY ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39402-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-261-5700
Provider Business Practice Location Address Fax Number:
601-261-5777
Provider Enumeration Date:
08/07/2024

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: 363LF0000X , with the licence number:  908222 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com