Provider Demographics
NPI:1639572167
Name:HOWARD, JACQUELINE HAVEN (PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HAVEN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 RIVERFRONT PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2193
Mailing Address - Country:US
Mailing Address - Phone:423-698-8981
Mailing Address - Fax:423-697-7109
Practice Address - Street 1:901 RIVERFRONT PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2193
Practice Address - Country:US
Practice Address - Phone:423-698-8981
Practice Address - Fax:423-697-7109
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2595363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant