Provider Demographics
NPI:1457493413
Name:HUTSON, SONDRA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:
Last Name:HUTSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3553
Mailing Address - Country:US
Mailing Address - Phone:575-628-5051
Mailing Address - Fax:575-628-0493
Practice Address - Street 1:5320 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9139
Practice Address - Country:US
Practice Address - Phone:575-392-1973
Practice Address - Fax:575-392-2030
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR26147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52983889Medicaid
NMNM006G19OtherBCBS
NMNM006G19OtherBCBS