Provider Demographics
NPI:1639670599
Name:HOWARD, KEVIN L SR
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:HOWARD
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 TOWERWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-2142
Mailing Address - Country:US
Mailing Address - Phone:423-228-5088
Mailing Address - Fax:423-803-6461
Practice Address - Street 1:6741 RINGGOLD RD STE F
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-4246
Practice Address - Country:US
Practice Address - Phone:423-228-5088
Practice Address - Fax:423-803-6461
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN82-4560868Other82-4560868
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