Provider Demographics
NPI:1427290071
Name:FOWLKES, REBECCA J (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:FOWLKES
Suffix:
Gender:
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 CHISWICK DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2562
Mailing Address - Country:US
Mailing Address - Phone:865-607-7357
Mailing Address - Fax:
Practice Address - Street 1:5214F DIAMOND HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2175
Practice Address - Country:US
Practice Address - Phone:865-607-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-28
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210612163WG0000X, 363LF0000X
TNRN0000145984163W00000X
OH1459842084P0800X
NH113537-232084P0800X
VA00241915752084P0800X
CT140382084P0800X
TNAPN0000014419363LF0000X
COC-APN.0002897-C-NP363LP0808X
COC-RXN.0001393-C-NP363LP0808X
KY4026747363LP0808X
TN14419363LP0808X
WAAP61599624363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily