Provider Demographics
NPI:1588213664
Name:KOWALSKI, AMI KATHLEEN (LNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:KATHLEEN
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:LNP, FNP-BC
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:KATHLEEN
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3063 WHITE SANDS CT
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8132
Mailing Address - Country:US
Mailing Address - Phone:603-508-1234
Mailing Address - Fax:
Practice Address - Street 1:3063 WHITE SANDS CT
Practice Address - Street 2:
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8132
Practice Address - Country:US
Practice Address - Phone:603-508-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily