MEDICARE: ANKLE & FOOT SPECIALISTS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP2539562	FL
2	367500000X	Certified Registered Nurse Anesthetist	ARNP2539562	FL
3	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2112	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10729640	OTHER	FL	CAQH

General Provider Information

NPI Number	:	1396994166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANKLE & FOOT SPECIALISTS PA

Provider Business Mailing Address
First Line	:	12385 SORRENTO RD
Second Line	:	SUITE D-4
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8664
Country	:	US
Telephone Number	:	850-497-8876
Fax Number	:	850-497-1721

Provider Business Practice Location Address
First Line	:	12385 SORRENTO RD
Second Line	:	SUITE D-4
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8664
Country	:	US
Telephone Number	:	850-497-8876
Fax Number	:	850-497-1721

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

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/15/2011

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Practice Location Address:

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Practice Location Address:

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Directions to “ANKLE & FOOT SPECIALISTS PA ” Practice Location

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