Provider Demographics
NPI:1760564637
Name:HUHN, STEPHANIE NICOLE (DO)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:HUHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:NICOLE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1605 MARTIN SPRINGS DR STE 230
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2980
Mailing Address - Country:US
Mailing Address - Phone:573-458-6326
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR STE 230
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2980
Practice Address - Country:US
Practice Address - Phone:573-458-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079837301Medicaid
TX715190OtherTX MCARE PREMIER