Healthcare Provider Details

I. General information

NPI: 1609436096
Provider Name (Legal Business Name): KASEY DAWN SUTTERFIELD APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HARRISON ST STE T
BATESVILLE AR
72501-7315
US

IV. Provider business mailing address

1700 HARRISON ST STE T
BATESVILLE AR
72501-7315
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-6155
  • Fax: 870-262-6512
Mailing address:
  • Phone: 870-262-6155
  • Fax: 870-262-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number121431
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06192323
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: