Provider Demographics
NPI:1194596700
Name:FOWLER, ZACHARY DANIEL (PMHNP)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DANIEL
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FM 423 APT 14115
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-3100
Mailing Address - Country:US
Mailing Address - Phone:817-852-9620
Mailing Address - Fax:
Practice Address - Street 1:11330 LEGACY DR STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1210
Practice Address - Country:US
Practice Address - Phone:469-221-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1140191363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health