Provider Demographics
NPI:1437417680
Name:FOWLER, KATHRYN POWELL (MPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:POWELL
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 WATHEN AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-2528
Mailing Address - Country:US
Mailing Address - Phone:214-263-4778
Mailing Address - Fax:
Practice Address - Street 1:8825 BEE CAVE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4720
Practice Address - Country:US
Practice Address - Phone:512-328-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant