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General NPI Number Information
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NPI Number | 1245648542
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Entity Type | Individual
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Provider Name | KATIE HUCKABY
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Gender | Female
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 4164 W COUNTY HIGHWAY 30A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-4336
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Country | US
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Telephone | 850-622-2313
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Fax | 850-622-2718
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Provider Business Mailing Address
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Address Line | 66 MARINER WAY
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-6931
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Country | US
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Telephone | 270-779-0143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3008797
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9490444
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License Number State | FL
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