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NPI Code Detail

MEDICARE: CRYSTAL SUTTON

MEDICARE: CRYSTAL 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
1163W00000XRegistered Nurse28186563AIN
2363LF0000XFamily Nurse Practitioner71005316AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619371119
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL SUTTON
Provider Business Mailing Address
First Line : 2121 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5100
Country : US
Telephone Number : 260-426-5431
Fax Number :
Provider Business Practice Location Address
First Line : 2121 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5100
Country : US
Telephone Number : 260-426-5431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2014
Last Update Date : 05/07/2026

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Directions to “ CRYSTAL SUTTON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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