Basic Information
| Provider Information | |||||||||
| NPI: | 1376174649 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AG-ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10523 DAY TRAIL LN | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773798278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564732464 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6720 BERTNER AVE STE O-520 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323552666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2020 | ||||||||
| LastUpdateDate: | 06/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 862888 | TX | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WC0200X | AP144735 | TX | Y | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.