Provider Demographics
NPI:1134143316
Name:FOWLER, JEWERLENE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:JEWERLENE
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9818 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4250
Mailing Address - Country:US
Mailing Address - Phone:501-257-1000
Mailing Address - Fax:501-257-5071
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:501-257-5071
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR15237163WP2201X
ARP00180363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health