Healthcare Provider Details

I. General information

NPI: 1114545381
Provider Name (Legal Business Name): JOSHUA CAINE HUCKABY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E MEMORIAL LN
JACKSBORO TN
37757-4702
US

IV. Provider business mailing address

153 E MEMORIAL LN
JACKSBORO TN
37757-4702
US

V. Phone/Fax

Practice location:
  • Phone: 423-912-5026
  • Fax:
Mailing address:
  • Phone: 423-912-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230380
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29652
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: