Provider Demographics
NPI:1962012070
Name:MAIN STREET ENDOCRINOLOGY, PLLC
Entity Type:Organization
Organization Name:MAIN STREET ENDOCRINOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:417-825-7920
Mailing Address - Street 1:10360 WINDY TRL
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7380
Mailing Address - Country:US
Mailing Address - Phone:417-825-7920
Mailing Address - Fax:
Practice Address - Street 1:165 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CAVE SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72718
Practice Address - Country:US
Practice Address - Phone:417-825-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty