MEDICARE: TRACY M FOWLER APRN/PNP

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	363LP0200X	Pediatric Nurse Practitioner	5376397	KS

General Provider Information

NPI Number	:	1801201173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY M FOWLER APRN/PNP

Provider Business Mailing Address
First Line	:	PO BOX 1215
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67905-1215
Country	:	US
Telephone Number	:	620-624-0732
Fax Number	:	620-624-2513

Provider Business Practice Location Address
First Line	:	555 W 15TH ST STE A
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2461
Country	:	US
Telephone Number	:	620-624-0702
Fax Number	:	620-624-2513

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	03/06/2026

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