Andre Michael Huddleston Sr.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

11879 Fire Agate Way
Rancho Cordova, CA 95742-8068

Phone

(916) 549-0821

NPI assigned

May 17, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1881041002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11879 FIRE AGATE WAY",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "957428068",
            "telephone_number": "916-549-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11879 FIRE AGATE WAY",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "957428068",
            "telephone_number": "916-549-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDDLESTON",
        "first_name": "ANDRE",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-17",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "171M00000X",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David M Houck, OT
• Amanda Tammy Howard
• Carl Chao Chia Hsu, MD
• Owen Y Hsu, OD
• Virginia Hua-Chian Hsu, M.D.
• Coleman Alan Humbert, NP
• Hung Anh Ba Nguyen MD Incorported
• Hung G Hoang MD Incorporated
• Hung-Anh Ba Nguyen, M.D., Inc
• Darryl C. Hunter, MD

• Community Health Worker in Rancho Cordova, CA
• Providers in Rancho Cordova, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.