Healthcare Provider Details

I. General information

NPI: 1760683163
Provider Name (Legal Business Name): CHRISTINE BOWERS HUTTO RN FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 N CROATAN HWY BEACH MEDICAL CARE
KITTY HAWK NC
27949
US

IV. Provider business mailing address

160 S DOGWOOD TRAIL
KITTY HAWK NC
27949-3136
US

V. Phone/Fax

Practice location:
  • Phone: 252-261-4187
  • Fax: 252-261-1922
Mailing address:
  • Phone: 252-255-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN120931
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: