Provider Demographics
NPI:1578083440
Name:FOWLER, JESSICA I (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:I
Last Name:FOWLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:I
Other - Last Name:KIMBREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:719 S OPDYKE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3436
Mailing Address - Country:US
Mailing Address - Phone:248-333-2600
Mailing Address - Fax:248-333-3250
Practice Address - Street 1:719 S OPDYKE RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3436
Practice Address - Country:US
Practice Address - Phone:248-333-2600
Practice Address - Fax:248-333-3250
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily