Healthcare Provider Details

I. General information

NPI: 1144250002
Provider Name (Legal Business Name): KIMBERLY ANN HUTTON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 ODDIE BLVD
SPARKS NV
89431
US

IV. Provider business mailing address

680 S ROCK BLVD
RENO NV
89502-4113
US

V. Phone/Fax

Practice location:
  • Phone: 775-997-7300
  • Fax: 775-997-7350
Mailing address:
  • Phone: 775-329-6300
  • Fax: 775-348-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7677-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: