Healthcare Provider Details

I. General information

NPI: 1326962168
Provider Name (Legal Business Name): CRISTY LEE HUTTO RN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 FAIR PARK BLVD
LITTLE ROCK AR
72204-2700
US

IV. Provider business mailing address

1509 FAIR PARK BLVD
LITTLE ROCK AR
72204-2700
US

V. Phone/Fax

Practice location:
  • Phone: 501-658-1033
  • Fax:
Mailing address:
  • Phone: 501-658-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR080892
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: