Provider Demographics
NPI:1497221006
Name:HUDDLESTON, SUZANNE R (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:R
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-257-6782
Mailing Address - Fax:417-257-5838
Practice Address - Street 1:181 N KENTUCKY AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2092
Practice Address - Country:US
Practice Address - Phone:417-257-5911
Practice Address - Fax:417-257-5913
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018024086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner