Provider Demographics
NPI:1457845760
Name:HUDDLESTON, KERRI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 COUNTY ROAD 1405
Mailing Address - Street 2:
Mailing Address - City:BOGATA
Mailing Address - State:TX
Mailing Address - Zip Code:75417-6171
Mailing Address - Country:US
Mailing Address - Phone:903-573-1670
Mailing Address - Fax:
Practice Address - Street 1:201 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-3737
Practice Address - Country:US
Practice Address - Phone:903-427-5682
Practice Address - Fax:855-406-2915
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily