Provider Demographics
NPI:1952878811
Name:HOWARD, KENNETH (APN)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 TEXAS AVE STE E
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-3501
Mailing Address - Country:US
Mailing Address - Phone:409-792-5521
Mailing Address - Fax:
Practice Address - Street 1:101 S PRAIRIE ST STE D
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2819
Practice Address - Country:US
Practice Address - Phone:936-257-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty