Provider Demographics
NPI:1376662833
Name:HUFFMAN, MIRANDA MCCANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:MCCANN
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRANDA
Other - Middle Name:SUE
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:918B FATHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:615-436-9060
Practice Address - Fax:615-235-9725
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNFH0201929207Q00000X
KS04-47372207Q00000X
MN73376207Q00000X
TXT9843207Q00000X
OH35.140812207Q00000X
FLME160925207Q00000X
MO2011020921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2011020921Medicaid
VA1376662833Medicaid
KS200741020AMedicaid
TNQ046194Medicaid