Provider Demographics
NPI:1619913431
Name:HUDDLESTON, ELLEN A (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:A
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:A
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 505
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-340-4655
Mailing Address - Fax:615-340-4596
Practice Address - Street 1:300 20TH AVE N STE 505
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-340-4655
Practice Address - Fax:615-340-4596
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL970022269OtherMEDICARE RR
FLP41044Medicare UPIN