Healthcare Provider Details

I. General information

NPI: 1336148519
Provider Name (Legal Business Name): PORTIA S HUTCHINSON IX NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 BRIARCLIFF AVE
OAK RIDGE TN
37830
US

IV. Provider business mailing address

653 BRIARCLIFF AVE
OAK RIDGE TN
37830
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-6080
  • Fax: 865-482-4070
Mailing address:
  • Phone: 865-482-6080
  • Fax: 865-482-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN59481
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN5771
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000005771
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: