=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689607343
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOYCE FOWLER, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 06/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 N MCKINLEY ST STE 500
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-6632
-----------------------------------------------------
Fax | 501-664-1441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 N MCKINLEY ST STE 500
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-6632
-----------------------------------------------------
Fax | 501-664-1441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOYCE FOWLER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 501-664-6632
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 03-13P
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------