1982686945 NPI number — KELLY ANN WATSON HUFFER CRNP

Table of content: KELLY ANN WATSON HUFFER CRNP (NPI 1982686945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982686945 NPI number — KELLY ANN WATSON HUFFER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON HUFFER
Provider First Name:
KELLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
KELLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982686945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 SAINT PAUL ST STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONSBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21713-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-432-6897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 SAINT PAUL ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONSBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21713-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-432-6897
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2005

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: 163W00000X , with the licence number:  R100502 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: R100502 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 506600000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00007022 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1982686945 . This is a "MEDICAID NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".