Provider Demographics
NPI:1609436096
Name:SUTTERFIELD, KASEY DAWN (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:DAWN
Last Name:SUTTERFIELD
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HARRISON ST STE T
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7315
Mailing Address - Country:US
Mailing Address - Phone:870-262-6155
Mailing Address - Fax:870-262-6512
Practice Address - Street 1:1700 HARRISON ST STE T
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7315
Practice Address - Country:US
Practice Address - Phone:870-262-6155
Practice Address - Fax:870-262-6512
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR121431363LF0000X
ARF06192323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program