Provider Demographics
NPI:1326088188
Name:HOWERTON, GRANVILLE G (RN-FNP)
Entity Type:Individual
Prefix:
First Name:GRANVILLE
Middle Name:G
Last Name:HOWERTON
Suffix:
Gender:M
Credentials:RN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W MCDERMOTT DR
Mailing Address - Street 2:SUITE 116, PMB 348
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:214-315-6310
Mailing Address - Fax:214-383-0089
Practice Address - Street 1:169 LAKE PARK RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-2303
Practice Address - Country:US
Practice Address - Phone:972-436-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598609363LF0000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122017001Medicaid
TXNP0110Medicare PIN
TXNP0111Medicare PIN
TXS40348Medicare UPIN