Provider Demographics
NPI:1508152935
Name:HUGHES, AMY NICHOLE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICHOLE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2224
Mailing Address - Country:US
Mailing Address - Phone:304-419-1211
Mailing Address - Fax:
Practice Address - Street 1:501 CALDWELL LN
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2026
Practice Address - Country:US
Practice Address - Phone:901-261-4848
Practice Address - Fax:901-261-4849
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV56208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP77843Medicare UPIN