Provider Demographics
NPI:1295575934
Name:HUDDLESTON, ANDREA NOEL (FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NOEL
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-8751
Mailing Address - Country:US
Mailing Address - Phone:417-499-4625
Mailing Address - Fax:
Practice Address - Street 1:620 W 32ND ST STE B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2528
Practice Address - Country:US
Practice Address - Phone:417-437-0303
Practice Address - Fax:417-553-4648
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024019215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily