Healthcare Provider Details

I. General information

NPI: 1245124288
Provider Name (Legal Business Name): BRIE KELLEY FOWLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIE KELLEY WETMORE

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CALIFORNIA DR
BURLINGAME CA
94010-4145
US

IV. Provider business mailing address

1265 ALEMANY BLVD
SAN FRANCISCO CA
94112-1403
US

V. Phone/Fax

Practice location:
  • Phone: 415-225-7656
  • Fax:
Mailing address:
  • Phone: 415-225-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number802658
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95033669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: