Provider Demographics
NPI:1396994166
Name:ANKLE & FOOT SPECIALISTS PA
Entity type:Organization
Organization Name:ANKLE & FOOT SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KINLEY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, CRNA
Authorized Official - Phone:850-497-8876
Mailing Address - Street 1:12385 SORRENTO RD
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8664
Mailing Address - Country:US
Mailing Address - Phone:850-497-8876
Mailing Address - Fax:850-497-1721
Practice Address - Street 1:12385 SORRENTO RD
Practice Address - Street 2:SUITE D-4
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8664
Practice Address - Country:US
Practice Address - Phone:850-497-8876
Practice Address - Fax:850-497-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2539562363L00000X, 367500000X
FLPO2112213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340655500Medicaid
FL307772100Medicaid
FL10729640OtherCAQH
FLE1032XMedicare PIN
FLBH773Medicare PIN
FL65187XMedicare PIN
FLT97664Medicare UPIN