Provider Demographics
NPI:1457656902
Name:FOWLER, SCOTT DARRON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DARRON
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2598
Mailing Address - Country:US
Mailing Address - Phone:615-867-7971
Mailing Address - Fax:615-867-7974
Practice Address - Street 1:155 LEGENDS DRIVE
Practice Address - Street 2:SUITE I
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-453-8999
Practice Address - Fax:615-453-8909
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02971363A00000X
TN2153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant