MR. BLAKE HUDDLESTON (NPI# 1700302171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700302171 |
| Entity Type | Individual |
| Full Name | MR. BLAKE HUDDLESTON |
| Credential | PA-C |
| Practice Address |
150 Sam Walton Dr Ste 300 Sparta TN 38583-8813 |
| Practice Telephone | 9317384060 |
| Mailing Telephone | 9317384060 |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2017-12-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
150 SAM WALTON DR STE 300 |
| City | SPARTA |
| State | TN |
| Zip Code | 38583-8813 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205393444 | Advanced Diagnostic Imaging, PC | Orthopaedic Surgery | 150 Sam Walton Dr Ste 300, Sparta, TN 38583-8813 | 2019-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538769047 | Results-ast Jv, LLC | Physical Therapist | 421 Sewell Road, Sparta, TN 38583 | 2020-10-26 |
| 1588282917 | Rock House Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 25 N Spring St, Sparta, TN 38583 | 2020-07-13 |
| 1881215333 | Nancy Marie Rutherford | Physical Therapist | 421 Sewell Drive, Sparta, TN 38583 | 2020-05-06 |
| 1942798210 | Oscar Dale Sims | Pharmacist | 202 Sam Walton Drive, Sparta, TN 38583 | 2018-04-23 |
| 1932622644 | Medicherla Shyam Sunder Kumar | Internal Medicine | 401 Sewell Road, Sparta, TN 38583 | 2017-07-25 |
| 1972852341 | Jtp Enterprises, LLC | Clinic/Center | 287 Turntable Rd., Sparta, TN 38583 | 2012-08-31 |
| 1154619898 | Abbie Howell | Pharmacist | 460 West Bockman Way, Sparta, TN 38583 | 2011-07-15 |
| 1164556759 | Leslie Ann Reagan | Pharmacist | 207 West Town Plaza, Sparta, TN 38583 | 2007-03-15 |
| 1497809875 | Waymon Haston | Dentist | 9-a Hampton Drive, Sparta, TN 38583 | 2007-01-22 |
| 1407920127 | Jeffry Alan Belknap | Internal Medicine | 809 W Bockman Way, Sparta, TN 38583 | 2006-11-17 |
| Find all providers in zip 38583 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437703741 | Providence Family Medicine | Physician Assistant | 287 W Turn Table Rd, Sparta, TN 38583-1366 | 2019-07-25 |
| 1649707373 | Cierra Nichole Walters | Physician Assistant | 464 Ghettis St, Sparta, GA 31087-2307 | 2017-05-12 |
| 1396797924 | Gary Detweiler | Physician Assistant | 475 S State St, Sparta, MI 49345-1549 | 2006-05-16 |
| 1992762116 | Dana Lakatos | Physician Assistant | 1300 N Market St, Sparta, IL 62286-1048 | 2006-05-01 |
| 1316583412 | Kayvon Ameri | Physician Assistant | 376 Lafayette Rd Ste 202, Sparta, NJ 07871-3560 | 2019-11-23 |
| 1497213078 | Lindsey A Crawford | Physician Assistant | 2111 12 Mile Rd Nw, Sparta, MI 49345-9754 | 2019-03-04 |
| 1447611082 | Julie Anne Vandermale | Physician Assistant | 475 S State St, Sparta, MI 49345-1549 | 2016-03-10 |
| 1154794865 | Botanical Emergency Physicians, LLC | Physician Assistant | 401 Sewell Dr, Sparta, TN 38583-1223 | 2015-11-03 |
| 1861896250 | Jenna Salvati | Physician Assistant | 2111 12 Mile Rd Nw, Sparta, MI 49345-9754 | 2014-10-15 |
| 1255730479 | Danielle Renee Preuss | Physician Assistant | 1300 N Market St, Sparta, IL 62286-1048 | 2014-08-14 |
| Find all providers in SPARTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.