Healthcare Provider Details

I. General information

NPI: 1598241721
Provider Name (Legal Business Name): BRANDY BROWNING FOWLER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 10/26/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PINEYWOOD RD
THOMASVILLE NC
27360-3438
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-8121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010681
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: