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General NPI Number Information
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NPI Number | 1124367214
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Entity Type | Individual
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Provider Name | DRELAN CHE-STEWART FOWLER PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 919 12TH PL STE 12
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City | PRESCOTT
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State | AZ
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Zip | 86305-1433
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Country | US
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Telephone | 928-227-1954
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Fax | 480-591-8225
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Provider Business Mailing Address
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Address Line | 919 12TH PL STE 12
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City | PRESCOTT
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State | AZ
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Zip | 86305-1433
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Country | US
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Telephone | 928-227-1954
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Fax | 480-591-8225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5344
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License Number State | AZ
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