Provider Demographics
NPI:1013576453
Name:HUGHES, KENNETH CHARLES
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHARLES
Last Name:HUGHES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 AUGUST ALP CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5302
Mailing Address - Country:US
Mailing Address - Phone:314-443-1490
Mailing Address - Fax:636-395-7002
Practice Address - Street 1:1065 MULLANPHY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-3232
Practice Address - Country:US
Practice Address - Phone:314-443-1490
Practice Address - Fax:636-395-7002
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC001629541253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care