Provider Demographics
NPI:1073058749
Name:SUTTLE, ANGELA D (APRN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:D
Last Name:SUTTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:STANICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7215
Mailing Address - Fax:501-865-2868
Practice Address - Street 1:6679 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929-7179
Practice Address - Country:US
Practice Address - Phone:501-865-2855
Practice Address - Fax:501-868-2868
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily