1164673661 NPI number — CHARLOTTE ELIZABETH HUTCHESON CASE MANAGER

Table of content: CHARLOTTE ELIZABETH HUTCHESON CASE MANAGER (NPI 1164673661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164673661 NPI number — CHARLOTTE ELIZABETH HUTCHESON CASE MANAGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTCHESON
Provider First Name:
CHARLOTTE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CASE MANAGER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164673661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
238 SUMMAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38301-3906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-541-8344
Provider Business Mailing Address Fax Number:
731-935-8327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2035 SAINT JOHN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DYERSBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38024-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-541-8344
Provider Business Practice Location Address Fax Number:
731-935-8327
Provider Enumeration Date:
10/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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