MEDICARE: KRONDA NICOLE HUDDLESTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28245427A	IN
2	163W00000X	Registered Nurse	28245427C	IN
3	3747P1801X	Personal Care Attendant
4	376J00000X	Homemaker
5	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1255074399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRONDA NICOLE HUDDLESTON

Provider Business Mailing Address
First Line	:	811 E PONTIAC ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-3459
Country	:	US
Telephone Number	:	260-704-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 BROADWAY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1509
Country	:	US
Telephone Number	:	260-704-5466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2022
Last Update Date	:	01/14/2025

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