Individual
KYLE BRUCE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4021 AVENUE B, SCOTTSBLUFF, NE 69361-4602
(308) 630-1947
(308) 630-1439
Mailing address
7815 S 196TH ST, GRETNA, NE 68028-5036
(719) 453-6568
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
12/20/2024
Last updated
12/20/2024
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