Provider Demographics
NPI:1790127017
Name:SUTTERFIELD, TRISHA ELAYNE
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ELAYNE
Last Name:SUTTERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 CEDAR MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-3106
Mailing Address - Country:US
Mailing Address - Phone:405-391-4266
Mailing Address - Fax:
Practice Address - Street 1:4801 CEDAR MILL RD
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-3106
Practice Address - Country:US
Practice Address - Phone:405-391-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily