Healthcare Provider Details

I. General information

NPI: 1245183862
Provider Name (Legal Business Name): WILLIAM HUCKABY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WALOSI WAY
LOUDON TN
37774-2504
US

IV. Provider business mailing address

129 WALOSI WAY
LOUDON TN
37774-2504
US

V. Phone/Fax

Practice location:
  • Phone: 209-747-9642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number336239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: