Healthcare Provider Details

I. General information

NPI: 1568224350
Provider Name (Legal Business Name): KRISTIN ROSE SUTTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HOMESTEAD CT
COLWICH KS
67030-9215
US

IV. Provider business mailing address

605 HOMESTEAD CT
COLWICH KS
67030-9215
US

V. Phone/Fax

Practice location:
  • Phone: 316-204-8301
  • Fax:
Mailing address:
  • Phone: 316-204-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-104951-062
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83139-062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: