Provider Demographics
NPI:1205132198
Name:FOWLKES, JENNA LEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LEE
Last Name:FOWLKES
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1275 DICK LONAS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1382
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:10215 KINGSTON PIKE STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3492
Practice Address - Country:US
Practice Address - Phone:865-691-0733
Practice Address - Fax:865-541-1727
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2019-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCTL 1618363A00000X
TN2142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant