Provider Demographics
NPI:1477210789
Name:HUGHES, KEVIN MICHAEL (PLACEMENTCOORDINATOR)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PLACEMENTCOORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11707 SHARPVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2807
Mailing Address - Country:US
Mailing Address - Phone:832-907-7063
Mailing Address - Fax:
Practice Address - Street 1:11707 SHARPVIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2807
Practice Address - Country:US
Practice Address - Phone:832-865-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111013172A00000X
TX104865364SP0812X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111013OtherMETROLIFT
TX45679657Medicaid
TX45679657OtherALL