Provider Demographics
NPI:1912906173
Name:MCHUGH, KATHLEEN M (PNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GASTON AVE
Mailing Address - Street 2:4 ROBERTS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-7701
Mailing Address - Country:US
Mailing Address - Phone:214-820-3000
Mailing Address - Fax:214-820-3022
Practice Address - Street 1:502 S OLD ORCHARD LN STE 126
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4374
Practice Address - Country:US
Practice Address - Phone:469-322-3665
Practice Address - Fax:972-353-5780
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX447480363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041502802Medicaid
TX060370604Medicaid
TX82N718Medicare ID - Type Unspecified00968R
TX060370604Medicaid
TX041502802Medicaid