Basic Information
| Provider Information | |||||||||
| NPI: | 1689073991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | JAMICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8220 MEADOWBRIDGE RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231162340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044170120 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8220 MEADOWBRIDGE RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231162340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044170120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2014 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024178212 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | 0024178212 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 0164889765 | 05 | VA | MEDICAID | MH5508506 | 01 | VA | DEA | OTHER | XH5508506 | 01 | VA | DEA | OTHER |