Provider Demographics
NPI:1780814327
Name:FOWLER, AMBER C (NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:C
Last Name:FOWLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:C
Other - Last Name:TALLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:P.O. BOX 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:864-233-8063
Mailing Address - Fax:864-233-2438
Practice Address - Street 1:3 ST. FRANCIS DR.
Practice Address - Street 2:STE 300
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3972
Practice Address - Country:US
Practice Address - Phone:864-233-8063
Practice Address - Fax:864-233-2438
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA5913Medicare PIN