Healthcare Provider Details

I. General information

NPI: 1548938764
Provider Name (Legal Business Name): KAYLEY HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 GETWELL RD BLDG B
SOUTHAVEN MS
38672-6455
US

IV. Provider business mailing address

2931 FLORA LEE DR S
NESBIT MS
38651-7004
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-2979
  • Fax: 662-349-2978
Mailing address:
  • Phone: 870-740-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number903808
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903808
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: