Healthcare Provider Details

I. General information

NPI: 1538695499
Provider Name (Legal Business Name): KAY DENISE HUFF LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 STEWART LN
MANSFIELD OH
44907-1575
US

IV. Provider business mailing address

610 STEWART LN
MANSFIELD OH
44907-1575
US

V. Phone/Fax

Practice location:
  • Phone: 567-303-4864
  • Fax:
Mailing address:
  • Phone: 567-303-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN048254MEDS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: