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General NPI Number Information
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NPI Number | 1194596700
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Entity Type | Individual
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Provider Name | ZACHARY DANIEL FOWLER PMHNP
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Gender | Male
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 11330 LEGACY DR STE 103
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City | FRISCO
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State | TX
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Zip | 75033-1210
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Country | US
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Telephone | 469-221-9267
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 FM 423 APT 14115
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City | FRISCO
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State | TX
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Zip | 75036-3100
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Country | US
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Telephone | 817-852-9620
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1140191
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License Number State | TX
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