Healthcare Provider Details

I. General information

NPI: 1285673277
Provider Name (Legal Business Name): CHARLOTTE N.P. HUTTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY # 71N
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

PO BOX 69004
ALEXANDRIA LA
71306-9004
US

V. Phone/Fax

Practice location:
  • Phone: 337-706-3489
  • Fax: 337-706-3461
Mailing address:
  • Phone: 337-706-3489
  • Fax: 337-706-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number200204
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200204
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: