Provider Demographics
NPI:1629049408
Name:HOWARD, KINLEY WAYNE (DPM, MD, CRNA)
Entity Type:Individual
Prefix:DR
First Name:KINLEY
Middle Name:WAYNE
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DPM, MD, CRNA
Other - Prefix:DR
Other - First Name:K
Other - Middle Name:W
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM, MD, CRNA
Mailing Address - Street 1:8550 SCENIC HWY APT G
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7921
Mailing Address - Country:US
Mailing Address - Phone:850-912-6559
Mailing Address - Fax:
Practice Address - Street 1:8550 SCENIC HWY APT G
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7921
Practice Address - Country:US
Practice Address - Phone:850-912-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2112213ES0103X
FLARNP2539562363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340655500Medicaid
FLG00EEOtherBCBS FLORIDA
FL10729640OtherCAQH
FL307772100Medicaid
FLE1032XMedicare PIN
FL307772100Medicaid
FLBH773Medicare PIN
FL65187XMedicare PIN