Provider Demographics
NPI:1730499443
Name:CORCORAN-SUTTER, KATHY M (NP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:CORCORAN-SUTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 STATE ROUTE 159 STE 280
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7502
Mailing Address - Country:US
Mailing Address - Phone:740-779-7050
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159 STE 280
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7502
Practice Address - Country:US
Practice Address - Phone:740-779-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-11659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily