Provider Demographics
NPI:1992277214
Name:HUCK, JODY SUE (NP-C)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:SUE
Last Name:HUCK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45744-7176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4010 RAINBOW RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:OH
Practice Address - Zip Code:45744-7176
Practice Address - Country:US
Practice Address - Phone:740-896-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.023878363LF0000X
WVAPRN71227-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily