Healthcare Provider Details

I. General information

NPI: 1801160742
Provider Name (Legal Business Name): MARY R FOWLER RN, BSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

4400 BROADWAY STE 510
KANSAS CITY MO
64111-3551
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012006262
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: