Provider Demographics
NPI:1639432297
Name:SUTTON, JESSICA A (AA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:SUTTON
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:LEHMKUHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:PO BOX 505313
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5313
Mailing Address - Country:US
Mailing Address - Phone:888-610-4566
Mailing Address - Fax:302-709-2407
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-577-8089
Practice Address - Fax:314-577-8003
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024983367H00000X
OH67000193367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant