Healthcare Provider Details

I. General information

NPI: 1366472565
Provider Name (Legal Business Name): MICHELE JOHNSON HUTCHENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 BETHANIA RURAL HALL RD
RURAL HALL NC
27045-9552
US

IV. Provider business mailing address

PROVIDER ENROLLMENT 100 KIMEL FOREST DRIVE
WINSTON-SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 367-169-2703
  • Fax: 336-702-9313
Mailing address:
  • Phone: 336-713-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00201
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: