Individual
DESTINEE BRIANA FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1492 TINY TOWN RD STE A1-A2, CLARKSVILLE, TN 37042-7873
(615) 553-5000
(615) 758-3875
Mailing address
745 TRACY LN UNIT 113, CLARKSVILLE, TN 37040-0064
(302) 399-5907
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4534
TN
Other
Enumeration date
04/09/2021
Last updated
07/19/2021
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