Healthcare Provider Details

I. General information

NPI: 1891419339
Provider Name (Legal Business Name): VICTORIA HOWERTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 169
WILLOW SPRINGS MO
65793-9603
US

IV. Provider business mailing address

214 W MAPLE ST
WEST PLAINS MO
65775-2817
US

V. Phone/Fax

Practice location:
  • Phone: 417-505-8469
  • Fax:
Mailing address:
  • Phone: 141-256-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number2019022316
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: