Provider Demographics
NPI:1255963609
Name:NOWELL, JOHN DENNIS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DENNIS
Last Name:NOWELL
Suffix:
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:PO BOX 97172
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39288-7172
Mailing Address - Country:US
Mailing Address - Phone:601-933-0038
Mailing Address - Fax:
Practice Address - Street 1:406 N BIERDEMAN RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4616
Practice Address - Country:US
Practice Address - Phone:601-933-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0377237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSHA0377OtherMS. DEPT. OF HEALTH