Healthcare Provider Details

I. General information

NPI: 1801410527
Provider Name (Legal Business Name): ELIZABETH A HUTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 W 6TH ST
WALDRON AR
72958-7642
US

IV. Provider business mailing address

1341 W 6TH ST
WALDRON AR
72958-7642
US

V. Phone/Fax

Practice location:
  • Phone: 479-637-2136
  • Fax: 479-637-5411
Mailing address:
  • Phone: 479-637-2136
  • Fax: 479-637-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84377
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-16569
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: