Provider Demographics
NPI:1184074890
Name:FOWLER, GENCY (RN)
Entity type:Individual
Prefix:MRS
First Name:GENCY
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 COLONEL ANDERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5517
Mailing Address - Country:US
Mailing Address - Phone:502-429-1249
Mailing Address - Fax:502-429-1255
Practice Address - Street 1:312 WHITTINGTON PKWY
Practice Address - Street 2:STE. 020
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4923
Practice Address - Country:US
Practice Address - Phone:502-429-1249
Practice Address - Fax:502-429-1255
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1064952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse