Provider Demographics
NPI:1245124288
Name:FOWLER, BRIE KELLEY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BRIE
Middle Name:KELLEY
Last Name:FOWLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRIE
Other - Middle Name:KELLEY
Other - Last Name:WETMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1265 ALEMANY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1403
Mailing Address - Country:US
Mailing Address - Phone:415-225-7656
Mailing Address - Fax:
Practice Address - Street 1:225 CALIFORNIA DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4145
Practice Address - Country:US
Practice Address - Phone:415-225-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802658163WX0200X
CA95033669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0200XNursing Service ProvidersRegistered NurseOncology