Individual
SCOTT FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
117 S 11TH AVE, LAUREL, MS 39440-4312
(601) 425-3033
(601) 422-0431
Mailing address
1093 NAQUIN RD, PURVIS, MS 39475-6051
(601) 520-3982
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
Primary
901535
MS
Other
Enumeration date
08/03/2016
Last updated
01/31/2017
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