Healthcare Provider Details

I. General information

NPI: 1386553790
Provider Name (Legal Business Name): MEGAN HUDDLESTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 HEALTH CENTER DR STE 100
MATTOON IL
61938-4637
US

IV. Provider business mailing address

PO BOX 372
MATTOON IL
61938-0372
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-4006
  • Fax: 217-258-4120
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: