Healthcare Provider Details

I. General information

NPI: 1932673795
Provider Name (Legal Business Name): SHELANIA MAY FOWLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 HUNTSVILLE HWY
FAYETTEVILLE TN
37334-3605
US

IV. Provider business mailing address

1421 HUNTSVILLE HWY
FAYETTEVILLE TN
37334-3605
US

V. Phone/Fax

Practice location:
  • Phone: 931-227-4197
  • Fax: 931-208-3396
Mailing address:
  • Phone: 931-227-4197
  • Fax: 931-208-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25374
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number25374
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: