Provider Demographics
NPI:1750625190
Name:HOWELL, KATY (PAC)
Entity type:Individual
Prefix:MS
First Name:KATY
Middle Name:
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 HENDERSON DR STE C1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5289
Mailing Address - Country:US
Mailing Address - Phone:910-548-2818
Mailing Address - Fax:
Practice Address - Street 1:3280 HENDERSON DR STE C1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5289
Practice Address - Country:US
Practice Address - Phone:910-548-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003654363A00000X
NC0010-04923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant