Provider Demographics
NPI:1275239675
Name:HUDDLESTON HEALTH LLC
Entity Type:Organization
Organization Name:HUDDLESTON HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-784-0142
Mailing Address - Street 1:210 OAK ST # 255
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2339
Mailing Address - Country:US
Mailing Address - Phone:870-784-0142
Mailing Address - Fax:
Practice Address - Street 1:1001 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2609
Practice Address - Country:US
Practice Address - Phone:918-649-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care