MEDICARE: JILL B FOWLER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	206	WV

General Provider Information

NPI Number	:	1043364342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL B FOWLER P.A.

Provider Business Mailing Address
First Line	:	150 PADUCAH DR
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-2710
Country	:	US
Telephone Number	:	304-455-8190
Fax Number	:	304-455-8131

Provider Business Practice Location Address
First Line	:	150 PADUCAH DR
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-2710
Country	:	US
Telephone Number	:	304-455-8190
Fax Number	:	304-455-8131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	04/18/2022

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