Provider Demographics
NPI:1154144194
Name:HUGHES, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:
Credentials:
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 116
Mailing Address - Street 2:
Mailing Address - City:EAST BANK
Mailing Address - State:WV
Mailing Address - Zip Code:25067-0116
Mailing Address - Country:US
Mailing Address - Phone:304-881-4155
Mailing Address - Fax:
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 700
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1230
Practice Address - Country:US
Practice Address - Phone:304-351-1600
Practice Address - Fax:304-351-1604
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1094392086S0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care