Provider Demographics
NPI:1295825172
Name:SUTLER, SUMMER NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:NICOLE
Last Name:SUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:NICOLE
Other - Last Name:TOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:
Practice Address - Street 1:105 STATE HIGHWAY 1947 # A
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-6825
Practice Address - Country:US
Practice Address - Phone:606-475-0152
Practice Address - Fax:606-474-4240
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100166350Medicaid
KYK066180Medicare PIN