Provider Demographics
NPI:1336424894
Name:HUGHES, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:HUGHES
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 1:6719 GOVERNOR GC PEERY HWY
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2484
Mailing Address - Country:US
Mailing Address - Phone:276-963-0333
Mailing Address - Fax:276-963-0222
Practice Address - Street 1:6719 GOVERNOR GC PEERY HWY
Practice Address - Street 2:SUITE 2600
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2484
Practice Address - Country:US
Practice Address - Phone:276-963-0333
Practice Address - Fax:276-963-0222
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169677363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09704Medicare PIN
DE2814Medicare PIN