Provider Demographics
NPI:1669090023
Name:HUCK, KELSEY (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HUCK
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 1:300 20TH AVE N FL 7
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2178
Mailing Address - Country:US
Mailing Address - Phone:615-284-1400
Mailing Address - Fax:615-284-1349
Practice Address - Street 1:300 20TH AVE N FL 7
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2178
Practice Address - Country:US
Practice Address - Phone:615-284-1400
Practice Address - Fax:615-284-1349
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN4536363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant