Provider Demographics
NPI:1811999667
Name:HOWELL, PHILIP MYRON (FNP)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MYRON
Last Name:HOWELL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3558A W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-9445
Mailing Address - Country:US
Mailing Address - Phone:662-346-8091
Mailing Address - Fax:662-499-6151
Practice Address - Street 1:3558A W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-9445
Practice Address - Country:US
Practice Address - Phone:662-346-8091
Practice Address - Fax:662-499-6151
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR822512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119591Medicaid
MS00119591Medicaid
MS500001948Medicare PIN