Basic Information
Provider Information | |||||||||
NPI: | 1073574737 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUFFNER | ||||||||
FirstName: | JEANNE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PAUL-ALLEN | ||||||||
OtherFirstName: | JEANNE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | FNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 109 PLAZA DR | ||||||||
Address2: |   | ||||||||
City: | SAINT CLAIRSVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 439507713 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7406952090 | ||||||||
FaxNumber: | 7406954116 | ||||||||
Practice Location | |||||||||
Address1: | 109 PLAZA DR | ||||||||
Address2: |   | ||||||||
City: | SAINT CLAIRSVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 439507713 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7406952090 | ||||||||
FaxNumber: | 7406954116 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/31/2006 | ||||||||
LastUpdateDate: | 04/02/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/02/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN39382-FNP-BC | WV | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APRN.CNP.12370 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 9600214000 | 05 | WV |   | MEDICAID | 2232908 | 05 | OH |   | MEDICAID |