Provider Demographics
NPI:1326089483
Name:SUTTON, RICHARD ANDERSON (FNP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANDERSON
Last Name:SUTTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-235-3432
Practice Address - Street 1:15 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8850
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-235-3432
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP111043363L00000X
NH042823-23-03363LF0000X
NC5005618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH4001485OtherFIRST CAROLINA CARE, INC
NCFH4001485OtherFIRST MEDICARE DIRECT
NCNC6421BMedicare PIN
NCFH4001485OtherFIRST CAROLINA CARE, INC