Healthcare Provider Details

I. General information

NPI: 1538706502
Provider Name (Legal Business Name): NICOLE LYNN HUTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. 250
HUTTONSVILLE WV
26241-2624
US

IV. Provider business mailing address

109 HCC BLVD
HUTTONSVILLE WV
26273
US

V. Phone/Fax

Practice location:
  • Phone: 304-338-6323
  • Fax: 304-335-6114
Mailing address:
  • Phone: 304-338-6323
  • Fax: 304-335-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number102592
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: