Healthcare Provider Details

I. General information

NPI: 1437740743
Provider Name (Legal Business Name): TYRA HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE 350
WASHINGTON DC
20003-3727
US

IV. Provider business mailing address

805 GREENFIELD DR APT 152
LYNCHBURG VA
24501-6332
US

V. Phone/Fax

Practice location:
  • Phone: 202-846-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: