Provider Demographics
NPI:1366172306
Name:HUGHES, JESSICA MAY MARIE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAY MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MAY MARIE
Other - Last Name:BOWSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 DUNKARD AVE
Mailing Address - Street 2:PO BOX 259
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349
Mailing Address - Country:US
Mailing Address - Phone:724-840-4765
Mailing Address - Fax:
Practice Address - Street 1:104 DUNKARD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349-3345
Practice Address - Country:US
Practice Address - Phone:724-840-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA664615163W00000X
WV90122163W00000X
WV115512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse