Provider Demographics
NPI:1104430487
Name:HUGLEY, DESTINY JOY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:JOY
Last Name:HUGLEY
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 1:939 HIGHLAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3834
Mailing Address - Country:US
Mailing Address - Phone:235-830-4899
Mailing Address - Fax:
Practice Address - Street 1:939 HIGHLAND AVE SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3834
Practice Address - Country:US
Practice Address - Phone:235-830-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health