Provider Demographics
NPI:1154154995
Name:HUGHES, KELLY (PMHNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14044 TRACK LN
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-3820
Mailing Address - Country:US
Mailing Address - Phone:804-824-5503
Mailing Address - Fax:
Practice Address - Street 1:8507 OXON HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4774
Practice Address - Country:US
Practice Address - Phone:804-824-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190850363LP0808X
MDAC007016363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health