Active NPI
Brooke Carolyn Fowler, MD
- Otolaryngology Physician
- Jackson, MS
National Provider Identifier
1295439172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- T-5119
- Practice address
- 2500 N State St
Jackson, MS 39216-4505 - Phone
- (601) 984-1000
- NPI assigned
- Mar 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | T-5119 | MS | Primary |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4505
Mailing address
4085 Eastwood Dr
Jackson, MS 39211-6442
Phone (620) 755-5492
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231106001661 | MS | Order and Referring Only - Otolaryngology | 7416304944 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-5119 | MS | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1295439172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4085 EASTWOOD DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392116442",
"telephone_number": "620-755-5492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164505",
"telephone_number": "601-984-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLER",
"first_name": "BROOKE",
"middle_name": "CAROLYN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-27",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MS",
"license": "T-5119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.