Provider Demographics
NPI:1689202707
Name:HOWARD, DESZTINI (MD)
Entity Type:Individual
Prefix:
First Name:DESZTINI
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NE ADAMS DAIRY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-5493
Mailing Address - Country:US
Mailing Address - Phone:816-251-6100
Mailing Address - Fax:
Practice Address - Street 1:600 NE ADAMS DAIRY PKWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-5493
Practice Address - Country:US
Practice Address - Phone:816-251-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023033193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine