Provider Demographics
NPI:1487236667
Name:STOW, BRIAN PATRICK (FNP-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:STOW
Suffix:
Gender:M
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 1:30926 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SQUAW VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93675-9601
Mailing Address - Country:US
Mailing Address - Phone:559-332-1112
Mailing Address - Fax:
Practice Address - Street 1:826 E MANNING AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2232
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95017182OtherCA NP LICENSE