Provider Demographics
NPI:1730170408
Name:HUTCHINSON, KIM M (EDD, APRN,BC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:M
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:EDD, APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 BARNWELL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9719
Mailing Address - Country:US
Mailing Address - Phone:336-748-8666
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER BLVD - 10 ARDMORE TOWER WESR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-2238
Practice Address - Fax:336-713-2242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC074886103T00000X, 163WA0400X, 163WP0808X
MD2005001113364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Not Answered364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health