Basic Information
| Provider Information | |||||||||
| NPI: | 1194775478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COMBS | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 280 | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416530280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063498100 | ||||||||
| FaxNumber: | 6063498150 | ||||||||
| Practice Location | |||||||||
| Address1: | 906 E MOUNTAIN PKWY | ||||||||
| Address2: | ALBAREE HEALTH SERVICES | ||||||||
| City: | SALYERSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 414658379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063498100 | ||||||||
| FaxNumber: | 6063498150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 06/01/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA776 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0536714 | 01 | KY | MEDICARE PTAN | OTHER | 9500457800 | 05 | KY | MEDICAID |