Healthcare Provider Details

I. General information

NPI: 1083784862
Provider Name (Legal Business Name): JON RYAN HUTCHINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 KITCHINGS DR
STATESVILLE NC
28677-3588
US

IV. Provider business mailing address

650 SIGNAL HILL DRIVE EXT. PO BOX 1845
STATESVILLE NC
28687
US

V. Phone/Fax

Practice location:
  • Phone: 704-838-8255
  • Fax: 704-871-9099
Mailing address:
  • Phone: 704-873-4277
  • Fax: 704-873-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11674
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13102
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200700297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: