Provider Demographics
NPI:1073899746
Name:HUDDLESTON, MEGAN E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:E
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1264 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6175
Mailing Address - Country:US
Mailing Address - Phone:931-484-1481
Mailing Address - Fax:931-484-1480
Practice Address - Street 1:1264 DAYTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6175
Practice Address - Country:US
Practice Address - Phone:931-484-4560
Practice Address - Fax:931-484-1480
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I978505Medicare PIN
103G708417Medicare PIN