Provider Demographics
NPI:1073840104
Name:HOWSAN, ANNJANETTE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:ANNJANETTE
Middle Name:MARIE
Last Name:HOWSAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNJANETTE
Other - Middle Name:M
Other - Last Name:FAIRCLOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4639 HERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-8358
Mailing Address - Country:US
Mailing Address - Phone:361-946-9267
Mailing Address - Fax:
Practice Address - Street 1:6215 HUMPHREYS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2367
Practice Address - Country:US
Practice Address - Phone:901-866-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28198963363LN0000X
IN71003771363LN0000X
TN18985363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201050090Medicaid