MEDICARE: KATHLEEN LAUREN HUFFMAN

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1336077536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN LAUREN HUFFMAN

Provider Business Mailing Address
First Line	:	389 HILL BRANCH RD APT 1203
Second Line	:
City	:	FLAT ROCK
State	:	NC
Zip	:	28731-1786
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	389 HILL BRANCH RD APT 1203
Second Line	:
City	:	FLAT ROCK
State	:	NC
Zip	:	28731-1786
Country	:	US
Telephone Number	:	850-524-0871
Fax Number	:

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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