Healthcare Provider Details

I. General information

NPI: 1982405502
Provider Name (Legal Business Name): MELISSA ANN SUTTON BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 LOST PRAIRIE RD
MARION MT
59925-9844
US

IV. Provider business mailing address

PO BOX 823
KILA MT
59920-0823
US

V. Phone/Fax

Practice location:
  • Phone: 406-407-5987
  • Fax: 480-646-3513
Mailing address:
  • Phone: 406-407-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberNUR-RN-LIC-45743
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: