Healthcare Provider Details

I. General information

NPI: 1124451281
Provider Name (Legal Business Name): CARLY HUTCHINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E SULLIVAN ST
KINGSPORT TN
37660-5242
US

IV. Provider business mailing address

1041 E SULLIVAN ST
KINGSPORT TN
37660-5242
US

V. Phone/Fax

Practice location:
  • Phone: 423-279-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000194197
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: