Healthcare Provider Details

I. General information

NPI: 1013026947
Provider Name (Legal Business Name): TONYA C HUGHEY CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BROOKWAY BLVD
BROOKHAVEN MS
39601-2644
US

IV. Provider business mailing address

940 BROOKWAY BLVD
BROOKHAVEN MS
39601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 601-823-5000
  • Fax: 601-823-4140
Mailing address:
  • Phone: 601-823-5000
  • Fax: 601-823-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR850440
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: