Healthcare Provider Details

I. General information

NPI: 1396994166
Provider Name (Legal Business Name): ANKLE & FOOT SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12385 SORRENTO RD SUITE D-4
PENSACOLA FL
32507-8664
US

IV. Provider business mailing address

12385 SORRENTO RD SUITE D-4
PENSACOLA FL
32507-8664
US

V. Phone/Fax

Practice location:
  • Phone: 850-497-8876
  • Fax: 850-497-1721
Mailing address:
  • Phone: 850-497-8876
  • Fax: 850-497-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2112
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2539562
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2539562
License Number StateFL

VIII. Authorized Official

Name: DR. KINLEY WAYNE HOWARD
Title or Position: OWNER
Credential: D.P.M, C.R.N.A.
Phone: 850-497-8876