Individual
MISS RONEFERITI MAISHIA FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
7945 WOLF RIVER BLVD, GERMANTOWN, TN 38138
(901) 683-0055
(901) 685-2969
Mailing address
7714 POPLAR AVE STE 200, GERMANTOWN, TN 38138-3941
(901) 683-0055
(901) 922-6722
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3272
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05722562
—
MS
05
—
Q026520
—
TN
Enumeration date
04/06/2007
Last updated
05/24/2018
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