Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 29287 | NE |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 43471 | IA |
NPI | 1134358500 |
---|---|
Provider Name | Dr. Kellen L Huston |
First Address | Council Bluffs, IA 51503-4658 |
Second Address | Council Bluffs, IA 51503-4658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 15/08/2016 |