Provider Demographics
NPI:1548938764
Name:HUFFMAN, KAYLEY
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 FLORA LEE DR S
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-7004
Mailing Address - Country:US
Mailing Address - Phone:870-740-3207
Mailing Address - Fax:
Practice Address - Street 1:5915 GETWELL RD BLDG B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6455
Practice Address - Country:US
Practice Address - Phone:662-349-2979
Practice Address - Fax:662-349-2978
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903808363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily