Destinee Briana Fowler, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4534 Issued in TN

Practice address

1492 Tiny Town Rd Ste A1-A2
Clarksville, TN 37042-7873

Phone

(615) 553-5000

Fax

(615) 758-3875

NPI assigned

Apr 9, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Destinee Briana Hagaman Former name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Privia Medical Group Tennessee LLC

  • Family Medicine Physician
  • Nashville, TN
  • NPI 1376110858

  Single Specialty

  Medicare reassignment NPD
• Seven Springs Orthopaedics, PC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Brentwood, TN
  • NPI 1194210005

  Single Specialty

  Medicare reassignment NPD
• Privia Medical Group Tennessee LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Nashville, TN
  • NPI 1215694229
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1033799564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 TRACY LN UNIT 113",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370400064",
            "telephone_number": "302-399-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1492 TINY TOWN RD STE A1-A2",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370427873",
            "telephone_number": "615-553-5000",
            "fax_number": "615-758-3875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4998 Crossings Cir Ste 200",
            "address_purpose": "LOCATION",
            "city": "MT Juliet",
            "state": "TN",
            "postal_code": "371220018",
            "country_code": "US",
            "telephone_number": "615-553-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "DESTINEE",
        "middle_name": "BRIANA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESTINEE",
            "last_name": "HAGAMAN",
            "middle_name": "BRIANA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Loy Allen Forsythe, MD
• Fort Campbell Chiropractic PLLC
• Ashley Foster, SOCIAL WORKER
• Laken Foster, LMSW
• Frances Margaret Foust
• Heather Patricia Fowler, RN
• Jeremy Fowler
• Katie Fowler
• Piper Fowler
• Jennifer Ellen Fox, MA, CCC-SLP

• Physician Assistant in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.