Provider Demographics
NPI:1376536714
Name:HUTCHINS, KEITH LEON JR (PA-C, DHSC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:LEON
Last Name:HUTCHINS
Suffix:JR
Gender:M
Credentials:PA-C, DHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-537-5631
Mailing Address - Fax:252-537-7198
Practice Address - Street 1:171 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6460
Practice Address - Country:US
Practice Address - Phone:252-537-5631
Practice Address - Fax:252-537-7198
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00581363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-00581OtherSTATE LICENSE
NC1376536714Medicaid
SC1009OtherSTATE LICENSE FOR PA'S
SC1009OtherSTATE LICENSE FOR PA'S