Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AG0117013 | MS |
N | 363LG0600X | Nurse Practitioner - Gerontology | AG0117013 | MS |
NPI | 1083106116 |
---|---|
Provider Name | Mrs. Michelle Hughes |
First Address | Byram, MS 39212-3265 |
Second Address | Ridgeland, MS 39157-5219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 04/06/2018 |