Provider Demographics
NPI:1912575408
Name:SUTTON, JOHN NICHOLAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:SUTTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24367 INCA RD # B611
Mailing Address - Street 2:
Mailing Address - City:INDIAN HILLS
Mailing Address - State:CO
Mailing Address - Zip Code:80454-5010
Mailing Address - Country:US
Mailing Address - Phone:808-392-9302
Mailing Address - Fax:
Practice Address - Street 1:24367 INCA RD # B611
Practice Address - Street 2:
Practice Address - City:INDIAN HILLS
Practice Address - State:CO
Practice Address - Zip Code:80454-5010
Practice Address - Country:US
Practice Address - Phone:808-392-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant