Provider Demographics
NPI:1801936513
Name:HUTTON, TRISHA RENE (ACNP)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:RENE
Last Name:HUTTON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E HATTIE GREENE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1918
Mailing Address - Country:US
Mailing Address - Phone:928-607-2607
Mailing Address - Fax:
Practice Address - Street 1:940 E HATTIE GREENE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1918
Practice Address - Country:US
Practice Address - Phone:928-607-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN094538163WR0006X
AZAP5442363LA2100X
IL209030762363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ903354Medicaid
AZZ170304Medicare PIN