Provider Demographics
NPI:1396754008
Name:HUGHES, MARY ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARY ELIZABETH
Middle Name:
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 1:5734 S 1475 E STE 300
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4698
Mailing Address - Country:US
Mailing Address - Phone:801-475-5210
Mailing Address - Fax:801-475-5209
Practice Address - Street 1:5734 S 1475 E STE 300
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4698
Practice Address - Country:US
Practice Address - Phone:801-475-5210
Practice Address - Fax:801-475-5209
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030622363AM0700X
UT14181147-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000150Medicaid
AP1904Medicare ID - Type Unspecified
VT9000150Medicaid