Provider Demographics
NPI:1790421709
Name:HUTCHERSON, TYESHIA R
Entity Type:Individual
Prefix:
First Name:TYESHIA
Middle Name:R
Last Name:HUTCHERSON
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 1:1540 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5095
Mailing Address - Country:US
Mailing Address - Phone:501-753-5459
Mailing Address - Fax:501-753-5463
Practice Address - Street 1:1540 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5095
Practice Address - Country:US
Practice Address - Phone:501-753-5459
Practice Address - Fax:501-753-5463
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213053163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse