Provider Demographics
NPI:1750544185
Name:HUTCHISON, STEPHANIE L (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6658
Mailing Address - Country:US
Mailing Address - Phone:830-258-6237
Mailing Address - Fax:830-895-7757
Practice Address - Street 1:2004 CUMBERLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1385
Practice Address - Country:US
Practice Address - Phone:606-248-3015
Practice Address - Fax:606-248-3024
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100136940Medicaid
OH3085067Medicaid