Provider Demographics
NPI:1720021405
Name:HOWARD, KELLI E (FNP - C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:E
Last Name:HOWARD
Suffix:
Gender:F
Credentials:FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3704
Mailing Address - Country:US
Mailing Address - Phone:806-788-1600
Mailing Address - Fax:
Practice Address - Street 1:4102 24TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1806
Practice Address - Country:US
Practice Address - Phone:806-725-6461
Practice Address - Fax:806-723-6334
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652340363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q40780Medicare UPIN