Provider Demographics
NPI:1356996573
Name:SUTTON, KATY (FNP)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:KINDER COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1250 W MOCKINGBIRD LN
Mailing Address - Street 2:STE 550
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4902
Mailing Address - Country:US
Mailing Address - Phone:469-904-3555
Mailing Address - Fax:
Practice Address - Street 1:1901 BELMONT DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4338
Practice Address - Country:US
Practice Address - Phone:903-238-5356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily