Provider Demographics
NPI:1922354877
Name:SUTTON, CRYSTAL GAYLE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAYLE
Last Name:SUTTON
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 1:1217 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4520
Mailing Address - Country:US
Mailing Address - Phone:870-972-1268
Mailing Address - Fax:870-934-0847
Practice Address - Street 1:800 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4176
Practice Address - Country:US
Practice Address - Phone:870-935-9911
Practice Address - Fax:870-935-3450
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160785526Medicaid