MEDICARE: KRISTIE L FOWLER MHPP

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1811144983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIE L FOWLER MHPP

Provider Business Mailing Address
First Line	:	100 S UNIVERSITY AVE STE 401
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5238
Country	:	US
Telephone Number	:	501-663-5473
Fax Number	:	500-801-1812

Provider Business Practice Location Address
First Line	:	100 S UNIVERSITY AVE STE 401
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5238
Country	:	US
Telephone Number	:	501-663-5473
Fax Number	:	500-801-1812

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

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	08/20/2008

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