Healthcare Provider Details

I. General information

NPI: 1134143316
Provider Name (Legal Business Name): JEWERLENE FOWLER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

9818 SURREY DR
LITTLE ROCK AR
72204-4250
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1000
  • Fax: 501-257-5071
Mailing address:
  • Phone: 501-257-1000
  • Fax: 501-257-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR15237
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberP00180
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: