Provider Demographics
NPI:1093707440
Name:HUGHES, JAYLYNN LYON (PAC)
Entity Type:Individual
Prefix:
First Name:JAYLYNN
Middle Name:LYON
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4250
Mailing Address - Country:US
Mailing Address - Phone:253-403-7257
Mailing Address - Fax:253-403-1340
Practice Address - Street 1:314 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4250
Practice Address - Country:US
Practice Address - Phone:253-403-7257
Practice Address - Fax:253-403-1340
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00387363AS0400X
WAPA10003016363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8436255Medicaid
OR210476Medicaid
OR210476Medicaid