Basic Information
| Provider Information | |||||||||
| NPI: | 1053813774 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FOWLER | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CPNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1384 HARBOR PARK DR | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381039031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183728676 | ||||||||
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| Practice Location | |||||||||
| Address1: | 262 DANNY THOMAS PLACE | ||||||||
| Address2: | SOLID TUMOR CLINIC | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015953300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2018 | ||||||||
| LastUpdateDate: | 03/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 24017 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.