Provider Demographics
NPI:1053868240
Name:SUTTERFIELD, COURTNEY (RD/RDN)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:SUTTERFIELD
Suffix:
Gender:F
Credentials:RD/RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 S SHORELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8795
Mailing Address - Country:US
Mailing Address - Phone:501-590-7823
Mailing Address - Fax:
Practice Address - Street 1:7909 S SHORELINE BLVD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-8795
Practice Address - Country:US
Practice Address - Phone:501-590-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1359133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered