Provider Demographics
NPI:1740748797
Name:HUFF, ANNABETH WALTERS (APRN, CPNP-AC/PC)
Entity Type:Individual
Prefix:
First Name:ANNABETH
Middle Name:WALTERS
Last Name:HUFF
Suffix:
Gender:F
Credentials:APRN, CPNP-AC/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:214-456-1358
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11342732080P0207X, 363LP0222X
FLAPRN94102802080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102316600Medicaid