Healthcare Provider Details

I. General information

NPI: 1750103545
Provider Name (Legal Business Name): TRACEY LYNN HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 CEDAR VALLEY DR
CEDAR BLUFF VA
24609-9190
US

IV. Provider business mailing address

3710 HOOT OWL RD
GRUNDY VA
24614-5996
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024191659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: