Healthcare Provider Details

I. General information

NPI: 1023503869
Provider Name (Legal Business Name): KATIE J HUTTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CARSON ST
JONESBORO AR
72401-3104
US

IV. Provider business mailing address

5512 CORDOVA LN
JONESBORO AR
72404-7814
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-7726
  • Fax:
Mailing address:
  • Phone: 870-588-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005765
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA005765
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: