Healthcare Provider Details

I. General information

NPI: 1225452535
Provider Name (Legal Business Name): KELLY HUFFMAN ARNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27524 CASHFORD CIR STE 102
WESLEY CHAPEL FL
33544-6947
US

IV. Provider business mailing address

27524 CASHFORD CIR STE 102
WESLEY CHAPEL FL
33544-6947
US

V. Phone/Fax

Practice location:
  • Phone: 815-212-1478
  • Fax: 813-906-7789
Mailing address:
  • Phone: 815-212-1478
  • Fax: 813-906-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9371614
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0997892-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9371614
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0997892-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9371614
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0997892-NP
License Number StateCO
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9371614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: