1013412972 NPI number — VALEEA JAMES SUTTON APRN

Table of content: VALEEA JAMES SUTTON APRN (NPI 1013412972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013412972 NPI number — VALEEA JAMES SUTTON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTTON
Provider First Name:
VALEEA
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1013412972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6135 PARK SOUTH DRIVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-285-2993
Provider Business Mailing Address Fax Number:
888-389-9720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6135 PARK SOUTH DRIVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-285-2993
Provider Business Practice Location Address Fax Number:
888-389-9720
Provider Enumeration Date:
03/23/2018

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:  21680 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 5016315 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP5390 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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