Healthcare Provider Details

I. General information

NPI: 1841863719
Provider Name (Legal Business Name): KERRI CONLIN HUTCHINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HOLCOMBE COVE RD
CANDLER NC
28715-9452
US

IV. Provider business mailing address

1207 GARREN CREEK ROAD
FAIRVIEW NC
28730-9452
US

V. Phone/Fax

Practice location:
  • Phone: 321-446-1612
  • Fax:
Mailing address:
  • Phone: 321-446-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number298013
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: