Provider Demographics
NPI:1962379222
Name:HUTCHISON, AUTUMN (BS)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:BS
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 84
Mailing Address - Street 2:
Mailing Address - City:NOTUS
Mailing Address - State:ID
Mailing Address - Zip Code:83656-0084
Mailing Address - Country:US
Mailing Address - Phone:208-697-7669
Mailing Address - Fax:
Practice Address - Street 1:22480 DUFF LN
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-6041
Practice Address - Country:US
Practice Address - Phone:208-965-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator