=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114941804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY I HUTSON DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 01/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2703 MOCKINGBIRD LN
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79109-3330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-351-2000
-----------------------------------------------------
Fax | 806-351-2060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2607 WOLFLIN AVE # 968
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79109-1825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-351-2000
-----------------------------------------------------
Fax | 806-351-2060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3248
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | K2721
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------