Healthcare Provider Details

I. General information

NPI: 1609312966
Provider Name (Legal Business Name): KYLIE ARIN HUTCHISON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

4642 NE PORTLAND HWY
PORTLAND OR
97218-1365
US

V. Phone/Fax

Practice location:
  • Phone: 800-949-1004
  • Fax:
Mailing address:
  • Phone: 503-519-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60699295
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201606908RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: