Provider Demographics
NPI:1598948762
Name:FOWLER, KYRA ASHLEY (FNP)
Entity Type:Individual
Prefix:MISS
First Name:KYRA
Middle Name:ASHLEY
Last Name:FOWLER
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:280 FORT SANDERS WEST BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3351
Practice Address - Country:US
Practice Address - Phone:865-539-2579
Practice Address - Fax:865-539-1502
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2020-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ031179Medicaid