Healthcare Provider Details

I. General information

NPI: 1568490621
Provider Name (Legal Business Name): ASHLEY MALCOM HUDDLESTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W ROSEDALE ST STE A
FORT WORTH TX
76104-2824
US

IV. Provider business mailing address

1 CHISHOLM TRAIL RD STE 5200
ROUND ROCK TX
78681-5090
US

V. Phone/Fax

Practice location:
  • Phone: 817-730-5300
  • Fax: 817-989-6819
Mailing address:
  • Phone: 512-202-3830
  • Fax: 512-354-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01059420A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: