Provider Demographics
NPI:1790389443
Name:HUGGINS, JEREMY WAYNE (RN)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:WAYNE
Last Name:HUGGINS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:JEREMY
Other - Middle Name:WAYNE
Other - Last Name:HUGGINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:24126 KELLING LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-6375
Mailing Address - Country:US
Mailing Address - Phone:636-297-1469
Mailing Address - Fax:
Practice Address - Street 1:24126 KELLING LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-6375
Practice Address - Country:US
Practice Address - Phone:636-297-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018022453163WR0400X, 163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation