Provider Demographics
NPI:1679360143
Name:FOWLER, KRISTEN GRACE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GRACE
Last Name:FOWLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 WATCHORN ST APT 405
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6890
Mailing Address - Country:US
Mailing Address - Phone:802-522-0360
Mailing Address - Fax:
Practice Address - Street 1:2021 WATCHORN ST APT 405
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6890
Practice Address - Country:US
Practice Address - Phone:802-522-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical