Healthcare Provider Details

I. General information

NPI: 1093698482
Provider Name (Legal Business Name): KAITLYN NICOLE HUGHES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CHESTERFIELD AVE
CHARLESTON WV
25304-1125
US

IV. Provider business mailing address

PO BOX 145
PRATT WV
25162-0145
US

V. Phone/Fax

Practice location:
  • Phone: 304-351-1700
  • Fax:
Mailing address:
  • Phone: 304-993-6609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number103552
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: