Provider Demographics
NPI:1679552012
Name:HOWELL, ELLEN O (FNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:O
Last Name:HOWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 THREE RIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2318
Mailing Address - Country:US
Mailing Address - Phone:573-686-5564
Mailing Address - Fax:573-686-2838
Practice Address - Street 1:2480 THREE RIVERS BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2318
Practice Address - Country:US
Practice Address - Phone:573-686-5564
Practice Address - Fax:573-686-2838
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS17453Medicare UPIN