Provider Demographics
NPI:1457837890
Name:HUDDLESTON, CASIE L (LPN)
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:L
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-1038
Mailing Address - Country:US
Mailing Address - Phone:330-831-3218
Mailing Address - Fax:
Practice Address - Street 1:1944 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-1038
Practice Address - Country:US
Practice Address - Phone:330-831-3218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.163065.MEDS-IV164W00000X
OH163065164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse