Provider Demographics
NPI:1871884049
Name:HUFF, JACQUELINE (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1060 LONGREEN DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8162
Mailing Address - Country:US
Mailing Address - Phone:606-471-4266
Mailing Address - Fax:336-294-2851
Practice Address - Street 1:111 GATEWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2999
Practice Address - Country:US
Practice Address - Phone:336-852-2550
Practice Address - Fax:336-294-2851
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07937363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant