Provider Demographics
NPI: | 1245288802 |
---|---|
Name: | HUGHES, MESHIA K (PA-C) |
Entity type: | Individual |
Prefix: | MRS |
First Name: | MESHIA |
Middle Name: | K |
Last Name: | HUGHES |
Suffix: | |
Gender: | F |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 510 LINCOLN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | HERRIN |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 62948-6334 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 618-997-6800 |
Mailing Address - Fax: | 618-997-1187 |
Practice Address - Street 1: | 510 LINCOLN DR |
Practice Address - Street 2: | |
Practice Address - City: | HERRIN |
Practice Address - State: | IL |
Practice Address - Zip Code: | 62948-6334 |
Practice Address - Country: | US |
Practice Address - Phone: | 618-997-6800 |
Practice Address - Fax: | 618-997-1187 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-05 |
Last Update Date: | 2023-07-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 085001578 | 207Q00000X, 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 203884 | Medicare PIN | |
IL | P76001 | Medicare UPIN | |
K08092 | Medicare UPIN | ||
IL | P76001 | Medicare UPIN |