Provider Demographics
NPI:1962940544
Name:HUFF, KATHLEEN ROUPRICH (PA-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ROUPRICH
Last Name:HUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:KERN
Other - Last Name:ROUPRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:178 HIGHWAY 24 E
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-4171
Mailing Address - Country:US
Mailing Address - Phone:601-890-0500
Mailing Address - Fax:601-645-5873
Practice Address - Street 1:178 HIGHWAY 24 E
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4171
Practice Address - Country:US
Practice Address - Phone:601-890-0500
Practice Address - Fax:601-645-5873
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00317363A00000X
LA310400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant