Provider Demographics
NPI:1225452535
Name:HUFFMAN, KELLY (ARNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:ARNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27524 CASHFORD CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6947
Mailing Address - Country:US
Mailing Address - Phone:815-212-1478
Mailing Address - Fax:813-906-7789
Practice Address - Street 1:27524 CASHFORD CIR STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6947
Practice Address - Country:US
Practice Address - Phone:815-212-1478
Practice Address - Fax:813-906-7789
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9371614363L00000X, 363LG0600X, 363LP2300X, 363LP0808X
COAPN.0997892-NP363LG0600X, 363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9371614OtherSTATE LICENSURE
FL010677300Medicaid
FLP01679243OtherRR MEDICARE
FLHS153W-HILLSBOROUGHMedicare PIN