Healthcare Provider Details

I. General information

NPI: 1033737309
Provider Name (Legal Business Name): CANDACE LINNEA HUTSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 02/11/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 PERKINS LN
JACKSBORO TN
37757-2833
US

IV. Provider business mailing address

163 PERKINS LN
JACKSBORO TN
37757-2833
US

V. Phone/Fax

Practice location:
  • Phone: 423-500-9140
  • Fax: 423-435-0828
Mailing address:
  • Phone: 423-500-9140
  • Fax: 423-435-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222980
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29087
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: