Active NPI
Audra Huddleston
- Licensed Practical Nurse
- Buckeye, AZ
National Provider Identifier
1790036416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LP049870
- Practice address
- 211 7TH Ave W
Buckeye, AZ 85326-1020 - Phone
- (623) 386-4487
- NPI assigned
- Sep 20, 2012
- Last updated
- Nov 17, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LP049870 | AZ | Primary |
Addresses
Primary practice location
211 7TH Ave W
Buckeye, AZ 85326-1020
Mailing address
10944 W Griswold Rd
Peoria, AZ 85345-2997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP049870 | AZ | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1790036416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10944 W GRISWOLD RD",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853452997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 7TH AVE W",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853261020",
"telephone_number": "623-386-4487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUDDLESTON",
"first_name": "AUDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-20",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "AZ",
"license": "LP049870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
- Hospital Development of West Phoenix Inc (Abrazo Buckeye Emergency Center)
- Matthew Tod Houlihan
- House of Tranquility Group Home LLC
- Anna Kristin House, COTA/L
- Cindy Lynn Howitt, LPN
- Raeosha Shanelle Huffman, BCBA
- Traci Hill Hulse, DVM
- Oluwajenrola Adeola Ibiyemi-Aluko
- Icare Total Health Services, Inc (Mindfit 360)
- Icarus House LLC.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.