Healthcare Provider Details

I. General information

NPI: 1730170408
Provider Name (Legal Business Name): KIM M HUTCHINSON EDD, APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER BLVD - 10 ARDMORE TOWER WESR
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

3771 BARNWELL DR
WINSTON SALEM NC
27105-9719
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-2238
  • Fax: 336-713-2242
Mailing address:
  • Phone: 336-748-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number074886
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number074886
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number2005001113
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number074886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: