Healthcare Provider Details

I. General information

NPI: 1184828865
Provider Name (Legal Business Name): PAMELA S HOWARD TBVI, ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 DAVIS DRIVE
OLIVE HILL KY
41164-8548
US

IV. Provider business mailing address

194 DAVIS DR
OLIVE HILL KY
41164-8548
US

V. Phone/Fax

Practice location:
  • Phone: 606-475-9077
  • Fax: 606-929-2143
Mailing address:
  • Phone: 606-475-9077
  • Fax: 606-929-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: