Provider Demographics
NPI:1821757865
Name:HUGHLEY, CHANNELL
Entity Type:Individual
Prefix:
First Name:CHANNELL
Middle Name:
Last Name:HUGHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6225
Mailing Address - Country:US
Mailing Address - Phone:513-804-6500
Mailing Address - Fax:
Practice Address - Street 1:4907 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6225
Practice Address - Country:US
Practice Address - Phone:513-804-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health