Provider Demographics
NPI:1215473780
Name:HOWARD, JESSICA WALLACE (MSN, AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:WALLACE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ROWE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7366
Mailing Address - Country:US
Mailing Address - Phone:256-571-8807
Mailing Address - Fax:
Practice Address - Street 1:55 ROWE DR
Practice Address - Street 2:SUITE C
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7366
Practice Address - Country:US
Practice Address - Phone:256-571-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117388363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner