Healthcare Provider Details

I. General information

NPI: 1982324943
Provider Name (Legal Business Name): DEANNA KAY HUTTON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N WALL AVE
FARMINGTON NM
87401-6916
US

IV. Provider business mailing address

PO BOX 5522
FARMINGTON NM
87499-5522
US

V. Phone/Fax

Practice location:
  • Phone: 505-258-4629
  • Fax: 505-436-2608
Mailing address:
  • Phone: 505-258-4629
  • Fax: 505-436-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2022-0399
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: