Healthcare Provider Details

I. General information

NPI: 1578227930
Provider Name (Legal Business Name): FOWLER RICHARDS SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

268 S SUNSET DR
WINSTON SALEM NC
27103-2836
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-4400
  • Fax:
Mailing address:
  • Phone: 864-497-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015255
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: