Provider Demographics
NPI:1033140413
Name:HUGHES, TERRY MITCHEL JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MITCHEL
Last Name:HUGHES
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CHARLESTON CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9153
Mailing Address - Country:US
Mailing Address - Phone:870-931-9964
Mailing Address - Fax:870-336-1134
Practice Address - Street 1:909 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-9201
Practice Address - Country:US
Practice Address - Phone:870-336-1100
Practice Address - Fax:870-336-1134
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01467367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X831OtherBCBS
AR5X831OtherBCBS