Tracy M Fowler, APRN/PNP
Individual provider Active NPI Pediatric Nurse Practitioner · Liberal, KS
NPI 1801201173 · NPPES record last updated Mar 6, 2026
Key facts
- NPI
- 1801201173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 5376397 (KS)
- Practice address
- 555 W 15TH St Ste a
Liberal, KS 67901-2461 - Phone
- (620) 624-0702
- Fax
- (620) 624-2513
- NPI assigned
- Jun 25, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170411002104 | KS | Practitioner - Nurse Practitioner | 4183900848 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5376397 | KS | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Medical Center | Current |
Accepting new patients | |
| Southwest Medical Center | Current |
Accepting new patients | |
| Southwest Medical Center | Past | Accepting new patients |
Locations
555 W 15th St
Liberal, KS 67901
Phone (620) 624-0702
555 W 15th St
Ste A
Liberal, KS 67901
Phone (620) 624-0702
2130 N Kansas Ave
Liberal, KS 67901
Phone (316) 626-5060
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JGBGAA
- fowltra@directswmedcenter.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 5376397 | KS | Yes |
Addresses
Primary practice location
555 W 15TH St Ste a
Liberal, KS 67901-2461
Mailing address
PO Box 1215
Liberal, KS 67905-1215
Phone (620) 624-0732
Other providers in Liberal, KS
- Earl James Fitzgerald
- Russell W Fitzgerald
- Karlo Marcelo Cleope Flores
- Lamberto Opulencia Flores
- FMS Midwest Dialysis Centers, LLC
- Fabiola Valentina Fraire
- Jana Rae Frantz
- Royce E Frazier
- Mark Vernon Garbutt
- Gill Internal Medicine L.L.C.
All providers in Liberal, KS · Pediatric Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.