KELLI MEGAN NICOLE HUTH


Address: 417 State St, Bangor, ME 04401-6630
Phone: 2079739382

KELLI MEGAN NICOLE HUTH (NPI# 1528558830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1528558830
Entity Type Individual
Full Name KELLI MEGAN NICOLE HUTH
Credential PA-C
Practice Address 417 State St
Bangor
ME 04401-6630
Mailing Address 43 Whiting Hill Rd Ste 300
Brewer
ME 04412-1006
Practice Telephone 2079739382
Enumeration Date 2018-05-11
Last Update Date 2020-06-09
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363AM0700X Physician Assistant
Specialization: Medical
4114 CT Physician Assistants & Advanced Practice Nursing Providers
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
PA2043 ME Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 417 STATE ST
City BANGOR
State ME
Zip Code 04401-6630

Providers in the same location

NPI Name Taxonomy Address Enumeration
1295731131 David Lawrence Levy Internal Medicine 417 State St, Ste 321, Bangor, ME 04401-6638 2005-06-24
1891304473 Kristina Lynn Leonard Nurse Practitioner 417 State St, Bangor, ME 04401-6630 2020-07-29
1770005670 Caitlin Dombrowski Psychologist 417 State St, Bangor, ME 04401 2017-07-12
1497281844 Jamie Hight Physician Assistant 417 State St, Webber East Suite 221, Bangor, ME 04401-6630 2017-05-04
1255871240 Courtney Lee Taylor Nurse Practitioner 417 State St, Webber East, Suite 421, Bangor, ME 04401-6630 2017-02-24
1083153977 Tyler Munro Physician Assistant 417 State St, Suite 340, Bangor, ME 04401 2017-02-13
1457802530 Carmen Jean Van Dusen Nurse Practitioner 417 State St, Suite 330, Bangor, ME 04401-6630 2016-10-24
1992187199 Erin Borges Physician Assistant 417 State St, Webber West Suite 340, Bangor, ME 04401-6630 2015-06-24
1750789897 Dahl Chase Diagnostic Services Clinical Medical Laboratory 417 State St, Suite 440, Bangor, ME 04401-6630 2014-12-05
1669870705 Dahl Chase Pathology Assoc. Pathology 417 State St, Suite 439, Bangor, ME 04401-6630 2014-12-05
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1184222523 Bj's Wholesale Club Inc. Eyewear Supplier (Equipment, not the service) 110 Longview Dr, Bangor, ME 04401 2020-10-16
1033737937 Daniel John Phulman Counselor 202 Exchange Street, Bangor, ME 04401 2020-07-08
1770104358 Elizabeth Sarah Caruson Physician Assistant 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 2020-05-05
1053961300 Erika Dean Occupational Therapist 84 Sylvan Rd., Bangor, ME 04401 2019-09-18
1942853635 Wildworks Therapy, Pllc Occupational Therapist 123 Mt Hope Ave, Bangor, ME 04401 2019-07-22
1255999173 Jessica Arbisi Physician Assistant 1 Northeast Drive, Bangor, ME 04401 2019-06-05
1699232041 Ehab Khamis Elhefnawi Anesthesiology Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 2019-02-21
1477028884 Zvorufura Makura Otolaryngology 885 Union Street, Ste 145, Bangor, ME 04401 2018-10-11
1255826541 Lindsey M Fields Optometrist 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 2018-06-28
1992211338 Debra J Mcintyre Counselor 157 Park Street, #5, Bangor, ME 04401 2017-12-21
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1679595433 John Nowak Physician Assistant 489 State Street, Eastern Maine Medical Center, Bangor, ME 04401 2006-07-24
1093730350 Melissa Becker Physician Assistant 925 Union St, Suite 3, Bangor, ME 04401-3051 2006-07-13
1356969521 Ashley Gilmore Physician Assistant 883 Union Street, Suite 145, Bangor, ME 04401 2020-07-14
1508496845 Jeremy Kent Wu Physician Assistant 55 Broadway Ste 2, Bangor, ME 04401-5201 2020-01-24
1922668466 Kathryn Dobrovolny Physician Assistant 417 State St Ste 330, Bangor, ME 04401-6638 2019-06-17
1063076461 Nicole Louise Robitaille Physician Assistant 417 State St Ste 330, Bangor, ME 04401-6638 2019-05-01
1356809883 Abigail Elizabeth Bobbitt Physician Assistant 417 State Street, Webber West, Suite 443, Bangor, ME 04401 2019-03-04
1023574357 Katherine Page Hintz Physician Assistant 55 Broadway Ste 2, Bangor, ME 04401-5201 2019-02-12
1992286546 Royce Blackwood Physician Assistant 360 Broadway, Bangor, ME 04401-3979 2018-08-22
1609383041 Alana Rive Silverman Physician Assistant 417 State St Ste 221, Bangor, ME 04401-6630 2018-01-08
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Competitor

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City BANGOR
Zip Code 04401

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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