Provider Demographics
NPI:1003509084
Name:HUTTO, KATIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:HUTTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 KETTLE RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-7300
Mailing Address - Country:US
Mailing Address - Phone:501-425-1178
Mailing Address - Fax:
Practice Address - Street 1:121 COX ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4611
Practice Address - Country:US
Practice Address - Phone:501-776-0691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124813163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse