Healthcare Provider Details

I. General information

NPI: 1568185437
Provider Name (Legal Business Name): ABBIGAIL HUDDLESTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1081
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8116-0049-3S34
SAINT LOUIS MO
63110-1081
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6006
  • Fax:
Mailing address:
  • Phone: 314-454-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024022548
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: