Provider Demographics
NPI:1871078857
Name:HUTCHERSON, NICOYA LONYEE
Entity type:Individual
Prefix:
First Name:NICOYA
Middle Name:LONYEE
Last Name:HUTCHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 LIVE OAK ST APT 214
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7675
Mailing Address - Country:US
Mailing Address - Phone:832-425-0977
Mailing Address - Fax:
Practice Address - Street 1:4928 LIVE OAK ST APT 214
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7675
Practice Address - Country:US
Practice Address - Phone:832-425-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340425164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse