Provider Demographics
NPI:1740258342
Name:HUFFMAN, KRISTINA LYNN (PAC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1180
Mailing Address - Country:US
Mailing Address - Phone:937-548-9680
Mailing Address - Fax:937-548-2087
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1180
Practice Address - Country:US
Practice Address - Phone:937-548-9680
Practice Address - Fax:937-548-2087
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001950363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1057200OtherNCCPA
OH50001950OtherSTATE MEDICAL BOARD