Provider Demographics
NPI:1083362198
Name:FOWLER, JENNIFER LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:FOWLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 CRESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5766
Mailing Address - Country:US
Mailing Address - Phone:864-978-7069
Mailing Address - Fax:
Practice Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3715
Practice Address - Country:US
Practice Address - Phone:864-442-4110
Practice Address - Fax:864-442-4126
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24963363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology