1972720548 NPI number — MRS. SHARON GAIL FOWLER FNP

Table of content: MRS. SHARON GAIL FOWLER FNP (NPI 1972720548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972720548 NPI number — MRS. SHARON GAIL FOWLER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
SHARON
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1972720548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 MOUNTAIN VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76021-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-656-4116
Provider Business Mailing Address Fax Number:
817-656-1707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4109 BROWN TRAIL
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
COLLEYVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-281-4446
Provider Business Practice Location Address Fax Number:
817-281-4990
Provider Enumeration Date:
04/18/2007

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:  425580 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com