Provider Demographics
NPI:1366017972
Name:HOWARD, NAMIKO SHOUYIN
Entity Type:Individual
Prefix:
First Name:NAMIKO
Middle Name:SHOUYIN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 ECHO DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4805
Mailing Address - Country:US
Mailing Address - Phone:423-368-1483
Mailing Address - Fax:
Practice Address - Street 1:1220 ECHO DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4805
Practice Address - Country:US
Practice Address - Phone:423-368-1483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCD15968Medicaid