Healthcare Provider Details

I. General information

NPI: 1962705848
Provider Name (Legal Business Name): KRISTEN ANN HUTCHISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6934 AVIATION BLVD SUITE B
GLEN BURNIE MD
21061-2593
US

IV. Provider business mailing address

12 STONE FALLS CT
NOTTINGHAM MD
21236-4760
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone: 410-533-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004348
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: