Healthcare Provider Details

I. General information

NPI: 1588213664
Provider Name (Legal Business Name): AMI KATHLEEN KOWALSKI LNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMI KATHLEEN FULLER

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3063 WHITE SANDS CT
HOLLOMAN AFB NM
88330-8132
US

IV. Provider business mailing address

3063 WHITE SANDS CT
HOLLOMAN AFB NM
88330-8132
US

V. Phone/Fax

Practice location:
  • Phone: 603-508-1234
  • Fax:
Mailing address:
  • Phone: 603-508-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177698
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: