1295985273 NPI number — JULIA TYE HUTT CRNP

Table of content: JULIA TYE HUTT CRNP (NPI 1295985273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295985273 NPI number — JULIA TYE HUTT CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTT
Provider First Name:
JULIA
Provider Middle Name:
TYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VASSAR
Provider Other First Name:
JULIA
Provider Other Middle Name:
TYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295985273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 FITNESS WAY STE. 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35611-2492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-232-0636
Provider Business Mailing Address Fax Number:
256-232-1281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 FITNESS WAY STE. 1200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35611-2492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-232-0636
Provider Business Practice Location Address Fax Number:
256-232-1281
Provider Enumeration Date:
09/25/2008

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: 363LF0000X , with the licence number:  1-081164 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD.20182 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 1-081164 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 114656 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-49763 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-49766 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529917320 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51517535 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 114651 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114655 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114650 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114652 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-49764 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-99966 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-49765 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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