Doctor Name: | KERI SUTTER |
NPI Number: | 1457731309 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 53-76821-021 |
Business Practice Address: | 2201 Se Austin St Oak Grove, MO - 640759255 |
Business Phone Number: | 8165476826 |
Business Fax Number: | |
Mailing Address: | 2201 Se Austin St, OAK GROVE |
State: | MO |
Postal Code: | 640759255 |
Phone Number: | 8165476826 |
Fax Number: | |
NPI Enumeration Date: | 06/05/2015 |
NPI Last Update Date: | 06/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 53-76821-021 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |