Provider Demographics
NPI:1538250626
Name:HUGHES, TRAVIS DARRELL (PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:DARRELL
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S MOHAWK DR STE E
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-2124
Mailing Address - Country:US
Mailing Address - Phone:423-330-6177
Mailing Address - Fax:423-330-6241
Practice Address - Street 1:800 S MOHAWK DR STE E
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2124
Practice Address - Country:US
Practice Address - Phone:423-330-6177
Practice Address - Fax:423-330-6241
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003724363A00000X
TN1432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3667244Medicare PIN
VAVV4037BMedicare PIN
TN103I973442Medicare PIN
TN103I970198Medicare PIN