MEDICARE: DR. JESSICA L HUTTO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	Q4136	TX
2	2084P0802X	Addiction Psychiatry Physician	Q4136	TX

General Provider Information

NPI Number	:	1164702403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA L HUTTO M.D.

Provider Business Mailing Address
First Line	:	18170 DALLAS PKWY
Second Line	:	SUITE 502
City	:	DALLAS
State	:	TX
Zip	:	75287-7137
Country	:	US
Telephone Number	:	972-243-3343
Fax Number	:	972-243-7324

Provider Business Practice Location Address
First Line	:	18170 DALLAS PKWY
Second Line	:	SUITE 502
City	:	DALLAS
State	:	TX
Zip	:	75287-7137
Country	:	US
Telephone Number	:	972-243-3343
Fax Number	:	972-243-7324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	12/27/2016

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