Provider Demographics
NPI:1477955177
Name:HUFFSTATLER, MARLANA (CFNP)
Entity Type:Individual
Prefix:
First Name:MARLANA
Middle Name:
Last Name:HUFFSTATLER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2628
Mailing Address - Country:US
Mailing Address - Phone:662-509-9934
Mailing Address - Fax:662-509-9935
Practice Address - Street 1:109 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2628
Practice Address - Country:US
Practice Address - Phone:662-509-9934
Practice Address - Fax:662-509-9935
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR877004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05830268Medicaid