Healthcare Provider Details

I. General information

NPI: 1497640338
Provider Name (Legal Business Name): DEBORAH HUGHES FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 FAIRGROUND RD STE A
GRENADA MS
38901-4516
US

IV. Provider business mailing address

875 W GOVAN ST
GRENADA MS
38901-3415
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-3711
  • Fax:
Mailing address:
  • Phone: 662-809-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number907469
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: