MEDICARE: MRS. BRIE KELLEY FOWLER FNP-C

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	163WX0200X	Oncology Registered Nurse	802658	CA
2	363L00000X	Nurse Practitioner	95033669	CA

General Provider Information

NPI Number	:	1245124288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIE KELLEY FOWLER FNP-C

Provider Business Mailing Address
First Line	:	1265 ALEMANY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1403
Country	:	US
Telephone Number	:	415-225-7656
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 CALIFORNIA DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4145
Country	:	US
Telephone Number	:	415-225-7656
Fax Number	:

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

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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