Healthcare Provider Details

I. General information

NPI: 1821628405
Provider Name (Legal Business Name): BRANDON WESLEY HUTCHISON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15921 BOUNDARY DR
ASHLAND MS
38603-7740
US

IV. Provider business mailing address

PO BOX 92
ASHALND MS
38603-9181
US

V. Phone/Fax

Practice location:
  • Phone: 662-224-8951
  • Fax:
Mailing address:
  • Phone: 662-502-3137
  • Fax: 662-224-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903797
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: