MEDICARE: JENNIFER FOWLER APRN

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	363LA2200X	Adult Health Nurse Practitioner	76072	KS
2	363LA2200X	Adult Health Nurse Practitioner	53-76072-051	KS

General Provider Information

NPI Number	:	1770916884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FOWLER APRN

Provider Business Mailing Address
First Line	:	20375 W 151ST ST
Second Line	:	SUITE 350
City	:	OLATHE
State	:	KS
Zip	:	66061-7209
Country	:	US
Telephone Number	:	913-355-9898
Fax Number	:	913-393-9893

Provider Business Practice Location Address
First Line	:	20375 W 151ST ST
Second Line	:	SUITE 350
City	:	OLATHE
State	:	KS
Zip	:	66061-7209
Country	:	US
Telephone Number	:	913-355-9898
Fax Number	:	913-393-9893

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	08/30/2022

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