Provider Demographics
NPI:1710006481
Name:HUTSON SIMONE, NICOLE R (APRN, CPNP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:R
Last Name:HUTSON SIMONE
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:BUSINESS CTR - INS CREDENTIALING
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-1682
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:15756 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1446
Practice Address - Country:US
Practice Address - Phone:985-318-6599
Practice Address - Fax:985-318-1386
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04664363LP0200X
MSR887980363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06179048Medicaid
LA1722961Medicaid