Provider Demographics
NPI:1548339567
Name:HUCKABEE, CARLA ANN (CNM)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANN
Last Name:HUCKABEE
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:1001 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4870
Mailing Address - Country:US
Mailing Address - Phone:870-236-9637
Mailing Address - Fax:870-236-9637
Practice Address - Street 1:800 S CHURCH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4176
Practice Address - Country:US
Practice Address - Phone:870-934-8808
Practice Address - Fax:870-268-8400
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARMO1020367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158095799Medicaid
AR158095799Medicaid
AR5Y513Medicare ID - Type Unspecified