MEDICARE: CRYSTAL MICHELLE HUGHLEY APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN124918	GA

General Provider Information

NPI Number	:	1598756140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MICHELLE HUGHLEY APRN, BC

Provider Business Mailing Address
First Line	:	407 LANCELOT TRL
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-6987
Country	:	US
Telephone Number	:	770-905-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 LANCELOT TRL
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-6987
Country	:	US
Telephone Number	:	770-905-9889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/12/2009

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