Provider Demographics
NPI:1598564023
Name:FOWLER, BAILEY MADYSON
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:MADYSON
Last Name:FOWLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 FOWLER RD
Mailing Address - Street 2:
Mailing Address - City:KUTTAWA
Mailing Address - State:KY
Mailing Address - Zip Code:42055-5628
Mailing Address - Country:US
Mailing Address - Phone:270-601-1682
Mailing Address - Fax:
Practice Address - Street 1:152 FOWLER RD
Practice Address - Street 2:
Practice Address - City:KUTTAWA
Practice Address - State:KY
Practice Address - Zip Code:42055-5628
Practice Address - Country:US
Practice Address - Phone:270-601-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant