Healthcare Provider Details

I. General information

NPI: 1154528313
Provider Name (Legal Business Name): MARY YVETTE STATON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS MARY YVETTE CUTSHAW

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N CHERRY ST
TULARE CA
93274-2251
US

IV. Provider business mailing address

5749 W COUNTRY AVE
VISALIA CA
93277-5502
US

V. Phone/Fax

Practice location:
  • Phone: 559-686-4766
  • Fax: 559-686-2016
Mailing address:
  • Phone: 559-739-8104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: