Provider Demographics
NPI:1649472523
Name:HUHN, KIMBERLY DENISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:HUHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 EYDE PKWY STE 175
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5378
Mailing Address - Country:US
Mailing Address - Phone:517-333-4600
Mailing Address - Fax:
Practice Address - Street 1:2852 EYDE PKWY STE 175
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5378
Practice Address - Country:US
Practice Address - Phone:517-333-4600
Practice Address - Fax:517-333-4996
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN42870009Medicare PIN