Healthcare Provider Details

I. General information

NPI: 1205526563
Provider Name (Legal Business Name): STEPHANIE DARLENE HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S JAMES CAMPBELL BLVD
COLUMBIA TN
38401
US

IV. Provider business mailing address

2316 TINDELL LN
COLUMBIA, TN TN
38401
US

V. Phone/Fax

Practice location:
  • Phone: 931-840-8525
  • Fax:
Mailing address:
  • Phone: 931-797-2192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000032773
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: