Provider Demographics
NPI:1992953285
Name:HUTCHERSON, JACQUELINE I (NP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:I
Last Name:HUTCHERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SWAN QUARTER
Mailing Address - State:NC
Mailing Address - Zip Code:27885
Mailing Address - Country:US
Mailing Address - Phone:252-926-4200
Mailing Address - Fax:
Practice Address - Street 1:1151 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SWAN QUARTER
Practice Address - State:NC
Practice Address - Zip Code:27885
Practice Address - Country:US
Practice Address - Phone:252-926-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201554363LF0000X
NC121367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife