1336250372 NPI number — DR. KELLIE C HUXEL PHD, LAT, ATC

Table of content: DR. KELLIE C HUXEL PHD, LAT, ATC (NPI 1336250372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336250372 NPI number — DR. KELLIE C HUXEL PHD, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUXEL
Provider First Name:
KELLIE
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336250372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C39 ARENA BLDG DEPARTMENT OF ATHLETIC TRAINING
Provider Second Line Business Mailing Address:
INDIANA STATE UNIVERSITY
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47809-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-237-7694
Provider Business Mailing Address Fax Number:
812-237-4368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
C39 ARENA BLDG DEPARTMENT OF ATHLETIC TRAINING
Provider Second Line Business Practice Location Address:
INDIANA STATE UNIVERSITY
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47809-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-237-7694
Provider Business Practice Location Address Fax Number:
812-237-4368
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: 2255A2300X , with the licence number:  36001242A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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