Provider Demographics
NPI:1437850567
Name:HUTSON, ALICIA DAWN
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DAWN
Last Name:HUTSON
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 1:4307 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:WV
Mailing Address - Zip Code:26180-3031
Mailing Address - Country:US
Mailing Address - Phone:434-279-9314
Mailing Address - Fax:
Practice Address - Street 1:4307 WALKER RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:WV
Practice Address - Zip Code:26180-3031
Practice Address - Country:US
Practice Address - Phone:434-279-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant