Provider Demographics
NPI:1063309656
Name:HUGGINS, KELLI JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:JEAN
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 PINEBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7830
Mailing Address - Country:US
Mailing Address - Phone:662-739-3576
Mailing Address - Fax:
Practice Address - Street 1:1651 W GOVERNMENT CV # A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2410
Practice Address - Country:US
Practice Address - Phone:601-487-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily