Healthcare Provider Details

I. General information

NPI: 1205437126
Provider Name (Legal Business Name): DANIELLE FOWERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W WASHINGTON AVE
RICHLAND MO
65556-7101
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 877-406-2662
  • Fax:
Mailing address:
  • Phone: 877-406-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020016680
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: