Healthcare Provider Details

I. General information

NPI: 1750092755
Provider Name (Legal Business Name): KIMBERLY SUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15011 MILLER MEADOWS LN
CYPRESS TX
77433-4422
US

IV. Provider business mailing address

15055 FAIRFIELD MEADOWS DR # 130-85
CYPRESS TX
77433-5394
US

V. Phone/Fax

Practice location:
  • Phone: 346-336-3039
  • Fax: 832-219-7757
Mailing address:
  • Phone: 346-336-3039
  • Fax: 832-219-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: