Provider Demographics
NPI:1639792203
Name:HUFFMAN, JOHNNY DELL (LPN, WCC, OMS)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:DELL
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:LPN, WCC, OMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13834 PARKS STEED DR
Mailing Address - Street 2:
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1405
Mailing Address - Country:US
Mailing Address - Phone:636-244-5258
Mailing Address - Fax:636-244-5261
Practice Address - Street 1:13834 PARKS STEED DR
Practice Address - Street 2:
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1405
Practice Address - Country:US
Practice Address - Phone:636-244-5258
Practice Address - Fax:636-244-5261
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008009865164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse