Healthcare Provider Details

I. General information

NPI: 1760038582
Provider Name (Legal Business Name): HANNAH MATHIS HUTSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071-9303
US

IV. Provider business mailing address

PO BOX 1258
WAYNESBORO TN
38485-1258
US

V. Phone/Fax

Practice location:
  • Phone: 270-854-1444
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax: 256-664-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3944
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: