Provider Demographics
NPI:1962161133
Name:HUGHES, NICOLE MCKENZIE (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MCKENZIE
Last Name:HUGHES
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SPRINGCREEK CT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2472
Mailing Address - Country:US
Mailing Address - Phone:803-385-7504
Mailing Address - Fax:
Practice Address - Street 1:308 SPRINGCREEK CT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2472
Practice Address - Country:US
Practice Address - Phone:803-385-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant