Provider Demographics
NPI:1821628405
Name:HUTCHISON, BRANDON WESLEY (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:WESLEY
Last Name:HUTCHISON
Suffix:
Gender:M
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:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ASHALND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-9181
Mailing Address - Country:US
Mailing Address - Phone:662-502-3137
Mailing Address - Fax:662-224-6801
Practice Address - Street 1:15921 BOUNDARY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-7740
Practice Address - Country:US
Practice Address - Phone:662-224-8951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily