Provider Demographics
NPI:1407418817
Name:HOWARD, KELLI ANN (LPN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 WIMBLETON CT APT B
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-4053
Mailing Address - Country:US
Mailing Address - Phone:574-310-5007
Mailing Address - Fax:
Practice Address - Street 1:4324 WIMBLETON CT APT B
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-4053
Practice Address - Country:US
Practice Address - Phone:574-310-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27032572A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse