Provider Demographics
NPI:1013902527
Name:SUTO, CATHLEEN CONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:CONNIE
Last Name:SUTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:P.O. BOX 540
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2154
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-784-8358
Practice Address - Street 1:550 SUNSET TRL
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2343
Practice Address - Country:US
Practice Address - Phone:423-784-5771
Practice Address - Fax:423-784-6185
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41746207V00000X
TN43450207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0297024OtherKY MEDICARE
KY41746OtherSTATE LICENSE
KY7100065240Medicaid
TN43450OtherSTATE LICENSE
KYFS1038430OtherDEA
TN43450OtherSTATE LICENSE