Basic Information
| Provider Information | |||||||||
| NPI: | 1184074890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | GENCY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 COLONEL ANDERSON PKWY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402225517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024291249 | ||||||||
| FaxNumber: | 5024291255 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 WHITTINGTON PKWY | ||||||||
| Address2: | STE. 020 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024291249 | ||||||||
| FaxNumber: | 5024291255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2016 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1064952 | KY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.