| Doctor Name: | JEANA KELLY FOWLER |
| NPI Number: | 1861403271 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN/ADM |
| License Number: | D6079682 |
| Business Practice Address: | 1449 W Main Pawhuska, OK - 74056 |
| Business Phone Number: | 9182875645 |
| Business Fax Number: | 9182875572 |
| Mailing Address: | 3329 Wooten Rd, BURBANK |
| State: | OK |
| Postal Code: | 74633 |
| Phone Number: | 9182877279 |
| Fax Number: | 9182875572 |
| NPI Enumeration Date: | 08/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA2000X |
| License Number: | D6079682 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | OK |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Administrator |
| Taxonomy Definition: | |