Provider Demographics
NPI:1043467772
Name:PARKER-SUTTON, NICOLE MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:PARKER-SUTTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 REEVES AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2418
Mailing Address - Country:US
Mailing Address - Phone:620-227-8306
Mailing Address - Fax:
Practice Address - Street 1:100 MILITARY AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4946
Practice Address - Country:US
Practice Address - Phone:620-227-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7252104100000X
KS42531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker