Provider Demographics
NPI:1871474072
Name:HUGHES, BROOKE CECELIA (NDTR)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:CECELIA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:C
Other - Last Name:MCCLASKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NDTR
Mailing Address - Street 1:715 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2955
Mailing Address - Country:US
Mailing Address - Phone:928-274-1605
Mailing Address - Fax:
Practice Address - Street 1:715 RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2955
Practice Address - Country:US
Practice Address - Phone:928-274-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Single Specialty