MEDICARE: PAMELA L FOWLER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1164301016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA L FOWLER RN

Provider Business Mailing Address
First Line	:	180 SUNNY HILL DR
Second Line	:
City	:	COLDSPRING
State	:	TX
Zip	:	77331-3225
Country	:	US
Telephone Number	:	346-988-6794
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 LAKE RD STE A-104
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-5737
Country	:	US
Telephone Number	:	346-799-0217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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