Healthcare Provider Details

I. General information

NPI: 1669159547
Provider Name (Legal Business Name): KALMISHA KYAUNTA HUFF CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 US HIGHWAY 80 E
DEMOPOLIS AL
36732-3605
US

IV. Provider business mailing address

11634 ANDREW WAY
TUSCALOOSA AL
35405-9696
US

V. Phone/Fax

Practice location:
  • Phone: 334-289-4000
  • Fax:
Mailing address:
  • Phone: 205-826-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-121284
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: