Healthcare Provider Details

I. General information

NPI: 1114227469
Provider Name (Legal Business Name): JAMES A HUTCHESON IV CPNP-AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST FL 2
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

49 N DUNLAP ST FL 2
MEMPHIS TN
38103-2802
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15318
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: