Basic Information
| Provider Information | |||||||||
| NPI: | 1083970446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUFF | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4030 SMITH RD | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452091957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134213494 | ||||||||
| FaxNumber: | 5133452606 | ||||||||
| Practice Location | |||||||||
| Address1: | 4030 SMITH RD | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452091957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134213494 | ||||||||
| FaxNumber: | 5133452606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 2010004382 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | APRN.CNP.11810 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 0139418 | 05 | OH | MEDICAID |