MEDICARE: JACLYN L HOWARD NP

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	163W00000X	Registered Nurse	RN112664	GA
2	363L00000X	Nurse Practitioner	RN112664	GA

General Provider Information

NPI Number	:	1831123330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN L HOWARD NP

Provider Business Mailing Address
First Line	:	PO BOX 2009
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30459-2009
Country	:	US
Telephone Number	:	912-764-3800
Fax Number	:	912-871-1901

Provider Business Practice Location Address
First Line	:	1 W ALTMAN ST
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5212
Country	:	US
Telephone Number	:	912-764-3800
Fax Number	:	912-871-1901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/28/2008

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