Healthcare Provider Details

I. General information

NPI: 1023103777
Provider Name (Legal Business Name): CAROL RENE HUFFMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL RENE PIPPIN FNP

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E G ST
ELIZABETHTON TN
37643-3223
US

IV. Provider business mailing address

403 EAST G STREET CARTER CO HEALTH DEPT
ELIZABETHTON TN
37643
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-2521
  • Fax: 423-543-7348
Mailing address:
  • Phone: 423-543-2521
  • Fax: 423-543-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN046141
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN05437
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: