Provider Demographics
NPI:1609519586
Name:HUTTO, KAITLYN ANNA
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANNA
Last Name:HUTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068-2000
Mailing Address - Country:US
Mailing Address - Phone:478-458-9942
Mailing Address - Fax:478-458-9969
Practice Address - Street 1:300 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068-2000
Practice Address - Country:US
Practice Address - Phone:478-458-9942
Practice Address - Fax:478-458-9969
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily