Healthcare Provider Details

I. General information

NPI: 1124857396
Provider Name (Legal Business Name): JAMIE RAE HUTCHISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39836 BAROQUE BLVD
CLINTON TWP MI
48038-2614
US

IV. Provider business mailing address

39836 BAROQUE BLVD
CLINTON TWP MI
48038-2614
US

V. Phone/Fax

Practice location:
  • Phone: 501-606-0887
  • Fax:
Mailing address:
  • Phone: 501-606-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601012513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: