Healthcare Provider Details

I. General information

NPI: 1003322900
Provider Name (Legal Business Name): LEONNA HUHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W FREEDOM DR
LIBERTY MS
39645-7295
US

IV. Provider business mailing address

2082 ERIC PRICE RD
TYLERTOWN MS
39667-6690
US

V. Phone/Fax

Practice location:
  • Phone: 601-657-8091
  • Fax: 601-657-8873
Mailing address:
  • Phone: 601-551-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902145
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG06170178
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: