Provider Demographics
NPI:1588101588
Name:HUGHES, LESTER II
Entity type:Individual
Prefix:MR
First Name:LESTER
Middle Name:
Last Name:HUGHES
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-3852
Mailing Address - Country:US
Mailing Address - Phone:228-218-0636
Mailing Address - Fax:228-205-2710
Practice Address - Street 1:1629 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-3852
Practice Address - Country:US
Practice Address - Phone:228-218-0636
Practice Address - Fax:228-205-2710
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01259254376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01259254Medicaid