Healthcare Provider Details

I. General information

NPI: 1669578001
Provider Name (Legal Business Name): KELLY COLLEEN HUFFMAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MOTOR ST
DALLAS TX
75235-7701
US

IV. Provider business mailing address

3208 ROBIN RD
PLANO TX
75075-7908
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-6370
  • Fax: 214-456-8317
Mailing address:
  • Phone: 214-456-6370
  • Fax: 214-456-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number555030
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: