Provider Demographics
NPI:1073278149
Name:HOWARD, KALI LARUE (AGACNP)
Entity Type:Individual
Prefix:MS
First Name:KALI
Middle Name:LARUE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 E RENNER RD APT 2219A
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2141
Mailing Address - Country:US
Mailing Address - Phone:832-693-8231
Mailing Address - Fax:
Practice Address - Street 1:4716 ALLIANCE BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5371
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1058160363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty