Healthcare Provider Details

I. General information

NPI: 1063951408
Provider Name (Legal Business Name): PHYLLIS A KENNEDY-HOWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 ARROWHEAD BLVD
JONESBORO GA
30236-1101
US

IV. Provider business mailing address

660 GORNTO CEMETERY RD
BARNEY GA
31625-3248
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-8687
  • Fax: 229-775-2223
Mailing address:
  • Phone: 229-456-2152
  • Fax: 229-775-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN189066
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number189066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: