Individual
FAYTHE HUTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
701 MCCLINTIC DR, GROESBECK, TX 76642-2128
(254) 729-3281
Mailing address
701 MCCLINTIC DR, GROESBECK, TX 76642-2128
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
1009839
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42121909
DRIVERS LICENSE
TX
Enumeration date
06/08/2021
Last updated
06/08/2021
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