Provider Demographics
NPI:1497124820
Name:HUGHEY, KENNETH MARVIN
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MARVIN
Last Name:HUGHEY
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 1:2420 W COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2420
Mailing Address - Country:US
Mailing Address - Phone:509-221-8745
Mailing Address - Fax:
Practice Address - Street 1:2420 W COURTLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2420
Practice Address - Country:US
Practice Address - Phone:509-221-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603527491171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor