Provider Demographics
NPI:1013351592
Name:HUDDLESTON, LINDA KELLEY (IBCLC, RN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KELLEY
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 CASTLEBAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1857
Mailing Address - Country:US
Mailing Address - Phone:704-733-7341
Mailing Address - Fax:
Practice Address - Street 1:8805 CASTLEBAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1857
Practice Address - Country:US
Practice Address - Phone:704-733-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090323163WL0100X
NC19714013174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN