Provider Demographics
NPI:1972720548
Name:FOWLER, SHARON GAIL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:GAIL
Last Name:FOWLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4172
Mailing Address - Country:US
Mailing Address - Phone:817-656-4116
Mailing Address - Fax:817-656-1707
Practice Address - Street 1:4109 BROWN TRAIL
Practice Address - Street 2:103
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-281-4446
Practice Address - Fax:817-281-4990
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX425580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP34983Medicare UPIN