Provider Demographics
NPI:1548005390
Name:HOWARD, MCKENNA KIMBERLY
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:KIMBERLY
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8903
Mailing Address - Country:US
Mailing Address - Phone:740-821-0748
Mailing Address - Fax:
Practice Address - Street 1:745 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8903
Practice Address - Country:US
Practice Address - Phone:740-821-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide