Provider Demographics
NPI:1083106116
Name:HUGHES, MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ESTORYA
Other - Middle Name:MICHELLE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:171 INEZ OWENS DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3265
Mailing Address - Country:US
Mailing Address - Phone:601-260-5028
Mailing Address - Fax:
Practice Address - Street 1:768 AVERY BLVD N
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5219
Practice Address - Country:US
Practice Address - Phone:601-487-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAG0117013363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology