Healthcare Provider Details

I. General information

NPI: 1649182494
Provider Name (Legal Business Name): KRISTEN LYNNE SUTTLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 WINDY RIDGE DR
SPRINGFIELD OH
45502-7211
US

IV. Provider business mailing address

3161 WINDY RIDGE DR
SPRINGFIELD OH
45502-7211
US

V. Phone/Fax

Practice location:
  • Phone: 937-346-4063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.410187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: