Individual
MRS. JENETRIA THOMAS HOWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-7100
Mailing address
7559 IRON LOOP, OLIVE BRANCH, MS 38654-1047
(601) 421-7433
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209-009035
IL
363LF0000X
Family Nurse Practitioner
Primary
246912
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041396248
REGISTERED NURSE LICENSE
IL
05
—
04927367
—
MS
01
—
209009035
ADVANCED PRACTICE NURSE LICENSE
IL
01
—
302I505779
MEDICARE ( PTAN)
—
Enumeration date
09/30/2010
Last updated
03/08/2021
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