Healthcare Provider Details

I. General information

NPI: 1982124822
Provider Name (Legal Business Name): JENNA MCLEAN FOWLKES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 USA MEDICAL CENTER DR
MOBILE AL
36617-2300
US

IV. Provider business mailing address

62 SILVERWOOD ST
MOBILE AL
36607-3410
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7300
  • Fax:
Mailing address:
  • Phone: 251-490-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-113749
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: