Healthcare Provider Details

I. General information

NPI: 1033140413
Provider Name (Legal Business Name): TERRY MITCHEL HUGHES JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ENTERPRISE DR
JONESBORO AR
72401-9201
US

IV. Provider business mailing address

401 CHARLESTON CV
JONESBORO AR
72404-9153
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-1100
  • Fax: 870-336-1134
Mailing address:
  • Phone: 870-931-9964
  • Fax: 870-336-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01467
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: