1093826463 NPI number — MRS. KATINA ENGLAND HUFF PA-C

Table of content: MRS. KATINA ENGLAND HUFF PA-C (NPI 1093826463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093826463 NPI number — MRS. KATINA ENGLAND HUFF PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUFF
Provider First Name:
KATINA
Provider Middle Name:
ENGLAND
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
KATINA
Provider Other Middle Name:
ENGLAND
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093826463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 622
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38583-0622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-808-1378
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 CHURCHILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38583-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-836-3262
Provider Business Practice Location Address Fax Number:
931-836-3269
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA633 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TN0102 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4071330 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10075889 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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