1720735897 NPI number — KERRI A HUCHTON

Table of content: KERRI A HUCHTON (NPI 1720735897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720735897 NPI number — KERRI A HUCHTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUCHTON
Provider First Name:
KERRI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1720735897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3372
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS LUNAS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87031-3372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-944-6626
Provider Business Mailing Address Fax Number:
505-359-3239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
536 LOS LENTES RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS LUNAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87031-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-944-6626
Provider Business Practice Location Address Fax Number:
505-359-3239
Provider Enumeration Date:
03/08/2022

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 822611640 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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