MEDICARE: KENNETH HOWARD APN

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	363LF0000X	Family Nurse Practitioner	AP139198	TX

General Provider Information

NPI Number	:	1952878811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH HOWARD APN

Provider Business Mailing Address
First Line	:	1650 TEXAS AVE STE E
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611-3501
Country	:	US
Telephone Number	:	409-792-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S PRAIRIE ST STE D
Second Line	:
City	:	DAYTON
State	:	TX
Zip	:	77535-2819
Country	:	US
Telephone Number	:	936-257-5117
Fax Number	:

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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Directions to “ KENNETH HOWARD APN” Practice Location

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