Provider Demographics
NPI:1457666356
Name:HOWARD, JACQUELINE LYNN
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LYNN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:LYNN
Other - Last Name:MATUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3303 W ILLINOIS AVE
Mailing Address - Street 2:STE 22
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-6213
Mailing Address - Country:US
Mailing Address - Phone:432-681-7617
Mailing Address - Fax:432-699-6290
Practice Address - Street 1:3303 W ILLINOIS AVE
Practice Address - Street 2:STE 22
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6213
Practice Address - Country:US
Practice Address - Phone:432-681-7617
Practice Address - Fax:432-699-6290
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689420163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health