Provider Demographics
NPI:1114545381
Name:HUCKABY, JOSHUA CAINE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CAINE
Last Name:HUCKABY
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E MEMORIAL LN
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-4702
Mailing Address - Country:US
Mailing Address - Phone:423-912-5026
Mailing Address - Fax:
Practice Address - Street 1:153 E MEMORIAL LN
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-4702
Practice Address - Country:US
Practice Address - Phone:423-912-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN230380163W00000X
TN29652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse