Healthcare Provider Details

I. General information

NPI: 1033234414
Provider Name (Legal Business Name): NATALIE SUZANNE HUTTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE SUZANNE HARRISON M.D.

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 NASHVILLE ST
RUSSELLVILLE KY
42276
US

IV. Provider business mailing address

480 HOPKINSVILLE ST
GREENVILLE KY
42345-1124
US

V. Phone/Fax

Practice location:
  • Phone: 270-726-9568
  • Fax: 270-726-9570
Mailing address:
  • Phone: 270-338-5777
  • Fax: 270-338-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number058870
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009-00195
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45772
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: