Provider Demographics
NPI:1831514306
Name:HUTCHISON, LARRAH E (PA)
Entity type:Individual
Prefix:
First Name:LARRAH
Middle Name:E
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LARRAH
Other - Middle Name:E
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23410
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-3410
Mailing Address - Country:US
Mailing Address - Phone:501-224-1690
Mailing Address - Fax:501-224-1927
Practice Address - Street 1:1 SAINT VINCENT CIR STE 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5407
Practice Address - Country:US
Practice Address - Phone:501-552-6830
Practice Address - Fax:501-552-4170
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-554363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT1405OtherTEMPORARY STATE LICENSE