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Individual

MATTHEW FOWLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
AGNP-C

Contact information

Practice address
1611 12TH AVE RD STE A, NAMPA, ID 83686-6182
(208) 546-3650
(208) 505-1947
Mailing address
1123 12TH AVE RD # 325, NAMPA, ID 83686-5738
(208) 546-3650
(208) 505-1947

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
63745
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
63745
ID

Other

Enumeration date
02/11/2020
Last updated
09/22/2025
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