Healthcare Provider Details

I. General information

NPI: 1922237031
Provider Name (Legal Business Name): BARBARA A HUTSON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 E MCARTHUR DR
SPRINGFIELD MO
65810-3233
US

IV. Provider business mailing address

522 E MCARTHUR DR
SPRINGFIELD MO
65810-3233
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-0032
  • Fax:
Mailing address:
  • Phone: 417-886-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number2001016639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: