Provider Demographics
NPI:1295191609
Name:DUTTON, LANDON
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:DUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 BALCH RD
Mailing Address - Street 2:STE 300
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8822
Mailing Address - Country:US
Mailing Address - Phone:256-325-1540
Mailing Address - Fax:256-774-9040
Practice Address - Street 1:2604 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1506
Practice Address - Country:US
Practice Address - Phone:256-445-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily