Provider Demographics
NPI:1457553877
Name:FOWLER, ALICIA FAYE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:FAYE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 LIPSCOMB ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4027
Mailing Address - Country:US
Mailing Address - Phone:903-640-4809
Mailing Address - Fax:903-640-4950
Practice Address - Street 1:505 LIPSCOMB ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4027
Practice Address - Country:US
Practice Address - Phone:903-640-4809
Practice Address - Fax:903-640-4950
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant