Provider Demographics
NPI:1811953284
Name:MCHUGH, KEVIN JOHN (CRNA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOHN
Last Name:MCHUGH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13846367500000X
ARC01485367500000X
TX812010367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284718802Medicaid
OK200395480AMedicaid
TX8929UBOtherBCBS
TX8867UGOtherBCBS TX
AR157662001Medicaid
TX284718801Medicaid
TXP00983541OtherRR MEDICARE
TXTXB137858Medicare PIN
TX8929UBOtherBCBS
AR157662001Medicaid