Provider Demographics
NPI:1538882659
Name:HUCKS, MIRANDA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:HUCKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26669 NEWBANKS RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-7592
Mailing Address - Country:US
Mailing Address - Phone:276-525-0031
Mailing Address - Fax:
Practice Address - Street 1:202 TOWN SQUARE ST
Practice Address - Street 2:
Practice Address - City:GLADE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24340-2924
Practice Address - Country:US
Practice Address - Phone:276-525-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine