Provider Demographics
NPI:1568224350
Name:SUTTON, KRISTIN ROSE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ROSE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HOMESTEAD CT
Mailing Address - Street 2:
Mailing Address - City:COLWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67030-9215
Mailing Address - Country:US
Mailing Address - Phone:316-204-8301
Mailing Address - Fax:
Practice Address - Street 1:605 HOMESTEAD CT
Practice Address - Street 2:
Practice Address - City:COLWICH
Practice Address - State:KS
Practice Address - Zip Code:67030-9215
Practice Address - Country:US
Practice Address - Phone:316-204-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-104951-062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse