Healthcare Provider Details

I. General information

NPI: 1639432297
Provider Name (Legal Business Name): JESSICA A SUTTON AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA A LEHMKUHL AA

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

PO BOX 505313
SAINT LOUIS MO
63150-5313
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8089
  • Fax: 314-577-8003
Mailing address:
  • Phone: 888-610-4566
  • Fax: 302-709-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number2013024983
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67000193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: