Healthcare Provider Details

I. General information

NPI: 1043533128
Provider Name (Legal Business Name): KERI LYNN SUTTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 E REPUBLIC RD STE K
SPRINGFIELD MO
65804-6519
US

IV. Provider business mailing address

1435 E BRADFORD PARKWAY SUITE 105
SPRINGFIELD MO
65804-6519
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-4994
  • Fax: 417-881-4998
Mailing address:
  • Phone: 417-881-4994
  • Fax: 417-881-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2010006173
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: