Healthcare Provider Details

I. General information

NPI: 1326971045
Provider Name (Legal Business Name): KIMBERLY RACHELL FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 CAMINO AL NORTE STE 230
NORTH LAS VEGAS NV
89031-2391
US

IV. Provider business mailing address

5135 CAMINO AL NORTE STE 230
NORTH LAS VEGAS NV
89031-2391
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-6727
  • Fax:
Mailing address:
  • Phone: 702-853-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: