Healthcare Provider Details

I. General information

NPI: 1790247500
Provider Name (Legal Business Name): JENNIFER DENIECE HUFFAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W VETERANS BLVD
BIG SPRING TX
79720-5566
US

IV. Provider business mailing address

2126 BUNKER HILL DR
ABILENE TX
79601-4792
US

V. Phone/Fax

Practice location:
  • Phone: 432-264-4869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP140132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: