Provider Demographics
NPI:1689174468
Name:SUTTLE, LEANNA MICHELLE (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:MICHELLE
Last Name:SUTTLE
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 1:637 SVENSON LANE
Mailing Address - Street 2:
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-6960
Mailing Address - Country:US
Mailing Address - Phone:432-853-0452
Mailing Address - Fax:
Practice Address - Street 1:1307 RIDGE RD APT 1106
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4333
Practice Address - Country:US
Practice Address - Phone:214-307-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-18
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX755072163W00000X
TXF01220833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse