MEDICARE: JESSICA SHARALE FOWLER PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0041144	OH

General Provider Information

NPI Number	:	1861359556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SHARALE FOWLER PMHNP

Provider Business Mailing Address
First Line	:	814 E 185TH ST STE 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-2775
Country	:	US
Telephone Number	:	216-394-2275
Fax Number	:	216-394-2275

Provider Business Practice Location Address
First Line	:	814 E 185TH ST STE 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-2775
Country	:	US
Telephone Number	:	216-394-2275
Fax Number	:	216-394-2275

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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