Healthcare Provider Details

I. General information

NPI: 1245557255
Provider Name (Legal Business Name): KELLY J HUGHES R.R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COFFEE RD
MODESTO CA
95355-4201
US

IV. Provider business mailing address

600 COFFEE RD
MODESTO CA
95355-4201
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-6097
  • Fax: 209-521-4081
Mailing address:
  • Phone: 209-521-6097
  • Fax: 209-521-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number10616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: