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General NPI Number Information
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NPI Number | 1861403271
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Entity Type | Individual
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Provider Name | JEANA KELLY FOWLER RN/ADM
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1449 W MAIN
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City | PAWHUSKA
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State | OK
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Zip | 74056
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Country | US
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Telephone | 918-287-5645
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Fax | 918-287-5572
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Provider Business Mailing Address
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Address Line | 3329 WOOTEN RD
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City | BURBANK
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State | OK
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Zip | 74633
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Country | US
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Telephone | 918-287-7279
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Fax | 918-287-5572
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | D6079682
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | D6079682
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License Number State | OK
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