Provider Demographics
NPI:1861895419
Name:HUCKABY, VIRGINIA SPICKLER
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SPICKLER
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:SPICKLER-ELAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:773 ESTATE PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-0600
Mailing Address - Country:US
Mailing Address - Phone:901-681-4040
Mailing Address - Fax:901-681-4052
Practice Address - Street 1:773 ESTATE PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-0600
Practice Address - Country:US
Practice Address - Phone:901-681-4040
Practice Address - Fax:901-681-4052
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17029363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics