Provider Demographics
NPI:1033234414
Name:HUTTON, NATALIE SUZANNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:SUZANNE
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:SUZANNE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:480 HOPKINSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-5777
Mailing Address - Fax:270-338-5765
Practice Address - Street 1:1497 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276
Practice Address - Country:US
Practice Address - Phone:270-726-9568
Practice Address - Fax:270-726-9570
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058870208000000X
NC2009-00195208000000X
KY45772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA866075888AMedicaid
KY7100231180Medicaid