Provider Demographics
NPI:1467791095
Name:HUGGINS, KATHLEEN ELIZABETH (RN, MS, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:RN, MS, IBCLC
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:HUGGINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MS, IBCLC
Mailing Address - Street 1:2705 MCMILLAN AVE
Mailing Address - Street 2:130
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4741
Mailing Address - Country:US
Mailing Address - Phone:805-541-1475
Mailing Address - Fax:805-541-1469
Practice Address - Street 1:746 HIGUERA ST
Practice Address - Street 2:4
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3501
Practice Address - Country:US
Practice Address - Phone:805-541-2026
Practice Address - Fax:805-783-1958
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230019163WL0100X
CA635364SP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatal
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant