Healthcare Provider Details

I. General information

NPI: 1740837194
Provider Name (Legal Business Name): GINNIFER POOLE HUTCHESON DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9035 E SANDIDGE RD STE 101
OLIVE BRANCH MS
38654-3563
US

IV. Provider business mailing address

9035 E SANDIDGE RD STE 101
OLIVE BRANCH MS
38654-3563
US

V. Phone/Fax

Practice location:
  • Phone: 662-408-4631
  • Fax: 662-408-4644
Mailing address:
  • Phone: 662-408-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number903495
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: