Provider Demographics
NPI:1649850132
Name:FOWLKES, KATRINA M (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:M
Last Name:FOWLKES
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 CARVED STONE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5249
Mailing Address - Country:US
Mailing Address - Phone:240-779-4503
Mailing Address - Fax:
Practice Address - Street 1:7209 CARVED STONE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5249
Practice Address - Country:US
Practice Address - Phone:240-779-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR228959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse