Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 53-78847-111 | KS |
NPI | 1003402413 |
---|---|
Provider Name | Theresa Howard |
First Address | Kansas City, KS 66160-8500 |
Second Address | Kansas City, KS 66160-8500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2020 |
Last Update Date | 19/12/2020 |