1457622078 NPI number — MS. CHRISTY LYNN SUTTON FNP

Table of content: MS. CHRISTY LYNN SUTTON FNP (NPI 1457622078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457622078 NPI number — MS. CHRISTY LYNN SUTTON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTTON
Provider First Name:
CHRISTY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457622078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 W IRONWOOD DRIVE
Provider Second Line Business Mailing Address:
SUITE 155
Provider Business Mailing Address City Name:
COEUR D'ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-4462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-772-8940
Provider Business Mailing Address Fax Number:
208-625-2075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1334 N WHITMAN LN
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019-6034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-6700
Provider Business Practice Location Address Fax Number:
509-688-6724
Provider Enumeration Date:
01/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP60658014 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: NP1151 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN00155459 . This is a "RN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1457622078 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: AP60658014 . This is a "ARNP LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2017335 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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