Provider Demographics
NPI:1487782249
Name:HUGHES, TINA A (CNM)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:A
Last Name:HUGHES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 WESTPORT RD STE D
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2950
Mailing Address - Country:US
Mailing Address - Phone:270-765-3301
Mailing Address - Fax:270-765-3928
Practice Address - Street 1:551D WEST PORT RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8606
Practice Address - Country:US
Practice Address - Phone:270-765-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3475M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW1144535Medicaid
KYP29971Medicare UPIN