Basic Information
| Provider Information | |||||||||
| NPI: | 1497155253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUETHER | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 W HIBISCUS BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329012620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218373820 | ||||||||
| FaxNumber: | 3218373654 | ||||||||
| Practice Location | |||||||||
| Address1: | 1775 W HIBISCUS BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329012620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218373820 | ||||||||
| FaxNumber: | 3218373654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | 222 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.