Healthcare Provider Details

I. General information

NPI: 1831824366
Provider Name (Legal Business Name): TYLER JON SUTTON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S MONROE ST
TACOMA WA
98405-1450
US

IV. Provider business mailing address

1405 S MONROE ST
TACOMA WA
98405-1450
US

V. Phone/Fax

Practice location:
  • Phone: 801-696-4551
  • Fax:
Mailing address:
  • Phone: 801-696-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61366229
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60927034
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: