Provider Demographics
NPI:1952397945
Name:HUGHES, VICKI R (PA-C)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:R
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 1:2162 W KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5368
Mailing Address - Country:US
Mailing Address - Phone:563-388-7000
Mailing Address - Fax:563-388-7001
Practice Address - Street 1:2162 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5368
Practice Address - Country:US
Practice Address - Phone:563-388-7000
Practice Address - Fax:563-388-7001
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002289363AM0700X
IL085000311363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306235072OtherGROUP NPI
1740349034OtherGROUP NPI
IA56266Medicare PIN
P06255OtherUPIN
IAIB1568Medicare PIN