Healthcare Provider Details

I. General information

NPI: 1558636415
Provider Name (Legal Business Name): ALLISON HUTTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON LANGREL NP

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MED TECH PKWY STE 100
JOHNSON CITY TN
37604-2392
US

IV. Provider business mailing address

303 MED TECH PKWY STE 100
JOHNSON CITY TN
37604-2392
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-5611
  • Fax: 423-282-5712
Mailing address:
  • Phone: 423-282-5611
  • Fax: 423-282-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16583
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: