Provider Demographics
NPI:1811213853
Name:FOWLER LUTKEN, ANN ELIZABETH (CFNP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ELIZABETH
Last Name:FOWLER LUTKEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:601-200-2990
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:971 LAKELAND DR STE 1250
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4609
Practice Address - Country:US
Practice Address - Phone:601-200-5955
Practice Address - Fax:601-200-5943
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875444163WE0003X
MS875444363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09702355Medicaid
MSP01668935OtherRAILROAD MEDICARE
MS09702355Medicaid