Provider Demographics
NPI:1104441849
Name:FOWLER, SHAMI LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:SHAMI
Middle Name:LYNN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:WRIGHT CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74766-0650
Mailing Address - Country:US
Mailing Address - Phone:580-981-2104
Mailing Address - Fax:580-981-2105
Practice Address - Street 1:207 W 10TH ST
Practice Address - Street 2:
Practice Address - City:WRIGHT CITY
Practice Address - State:OK
Practice Address - Zip Code:74766
Practice Address - Country:US
Practice Address - Phone:580-981-2104
Practice Address - Fax:580-981-2105
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK121401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine