Provider Demographics
NPI:1841057270
Name:FOWLER, KATIE (APRN,CNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:APRN,CNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 MESSER CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6390
Mailing Address - Country:US
Mailing Address - Phone:817-223-4858
Mailing Address - Fax:
Practice Address - Street 1:11801 SOUTH FWY STE 140
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7021
Practice Address - Country:US
Practice Address - Phone:817-551-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner