Healthcare Provider Details

I. General information

NPI: 1497679013
Provider Name (Legal Business Name): SAMUEL RAYMOND HOWARD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SAINT FRANCIS DR
CAPE GIRARDEAU MO
63703-5049
US

IV. Provider business mailing address

109 N 3RD ST
CHAFFEE MO
63740-1508
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-3000
  • Fax:
Mailing address:
  • Phone: 573-318-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number2018023881
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: