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General NPI Number Information
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NPI Number | 1659009470
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Entity Type | Individual
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Provider Name | KERI S FOWLER RDH
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Gender | Female
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 808 ROCKBRIDGE ST
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City | BLUEFIELD
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State | WV
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Zip | 24701-4546
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Country | US
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Telephone | 304-308-0059
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Fax |
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Provider Business Mailing Address
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Address Line | 808 ROCKBRIDGE ST
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City | BLUEFIELD
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State | WV
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Zip | 24701
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Country | US
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Telephone | 304-308-0059
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0402208344
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License Number State | VA
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