Provider Demographics
NPI:1720202989
Name:SUTTON, KRISTI G (MD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:G
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23157 I 30
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9905
Mailing Address - Country:US
Mailing Address - Phone:501-552-6850
Mailing Address - Fax:501-552-5310
Practice Address - Street 1:23157 I 30
Practice Address - Street 2:SUITE 101
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9905
Practice Address - Country:US
Practice Address - Phone:501-552-6850
Practice Address - Fax:501-552-5310
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5964207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178416001Medicaid
5H8227343Medicare PIN
5H8227470Medicare PIN