Provider Demographics
NPI:1528633898
Name:BURRELL-FOWLER, KAMELIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:KAMELIA
Middle Name:
Last Name:BURRELL-FOWLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 HOLLYWOOD RD STE 270
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9158
Mailing Address - Country:US
Mailing Address - Phone:269-983-0500
Mailing Address - Fax:269-429-2240
Practice Address - Street 1:3950 HOLLYWOOD RD STE 270
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9158
Practice Address - Country:US
Practice Address - Phone:269-983-0500
Practice Address - Fax:269-429-2240
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181262363LF0000X
MI4704397655363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily