Provider Demographics
NPI:1558636415
Name:HUTTO, ALLISON (NP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HUTTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:LANGREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:303 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2392
Mailing Address - Country:US
Mailing Address - Phone:423-282-5611
Mailing Address - Fax:423-282-5712
Practice Address - Street 1:303 MED TECH PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2392
Practice Address - Country:US
Practice Address - Phone:423-282-5611
Practice Address - Fax:423-282-5712
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I505418Medicare PIN