Individual
KIM M HUCKABY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8177 CLEARVISTA PKWY, INDIANAPOLIS, IN 46256-1662
(317) 621-7801
(317) 621-7205
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004769A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201210360
—
IN
01
—
PO1307685
MEDICAID RR PTAN
IN
Enumeration date
01/27/2014
Last updated
11/27/2023
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