MEDICARE: KIRK SUTTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1619308855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK SUTTON

Provider Business Mailing Address
First Line	:	6205 FARRINGTON RD
Second Line	:	APT G4
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-7845
Country	:	US
Telephone Number	:	919-942-4343
Fax Number	:	919-942-4338

Provider Business Practice Location Address
First Line	:	6205 FARRINGTON RD
Second Line	:	APT G4
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-7845
Country	:	US
Telephone Number	:	919-942-4343
Fax Number	:	919-942-4338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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