Healthcare Provider Details

I. General information

NPI: 1851895890
Provider Name (Legal Business Name): MRS. KRISTEN KEARNS HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258-2460
US

IV. Provider business mailing address

1612 STONEWOOD CT
ST AUGUSTINE FL
32092-3447
US

V. Phone/Fax

Practice location:
  • Phone: 904-271-6000
  • Fax:
Mailing address:
  • Phone: 904-626-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA11076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: