Provider Demographics
NPI:1649842675
Name:HUGHES, SHASTA (LVN, HCS-D, HCS-O)
Entity type:Individual
Prefix:
First Name:SHASTA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LVN, HCS-D, HCS-O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 GRAYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-1457
Mailing Address - Country:US
Mailing Address - Phone:214-457-1381
Mailing Address - Fax:
Practice Address - Street 1:3008 GRAYSTONE CT
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-1457
Practice Address - Country:US
Practice Address - Phone:214-457-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215390164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse