Provider Demographics
NPI:1578703732
Name:HOWARD, BETTY FLOSSIE (CHP-C)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:FLOSSIE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:CHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8029
Mailing Address - Street 2:
Mailing Address - City:CHENEGA BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99574-8029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5029 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHENEGA BAY
Practice Address - State:AK
Practice Address - Zip Code:99574-8029
Practice Address - Country:US
Practice Address - Phone:907-573-5129
Practice Address - Fax:907-573-5148
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDH0193Medicaid