Provider Demographics
NPI:1396208468
Name:FOWLER, CARLA JANE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JANE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 FM 1753
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-6247
Mailing Address - Country:US
Mailing Address - Phone:903-436-0654
Mailing Address - Fax:
Practice Address - Street 1:2615 FM 1753
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-6247
Practice Address - Country:US
Practice Address - Phone:903-436-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner