Provider Demographics
NPI:1265066138
Name:HOWARD, SARAH
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
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 16472
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-6472
Mailing Address - Country:US
Mailing Address - Phone:769-233-7026
Mailing Address - Fax:769-233-7026
Practice Address - Street 1:5880 RIDGEWOOD RD APT H65
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2628
Practice Address - Country:US
Practice Address - Phone:314-374-1201
Practice Address - Fax:769-233-7026
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO126103172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver