Provider Demographics
NPI:1659167682
Name:NUTTER, ANNETTE DAWN PRIDDY (ME)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:DAWN PRIDDY
Last Name:NUTTER
Suffix:
Gender:
Credentials:ME
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:DAWN PRIDDY
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ME
Mailing Address - Street 1:600 COUNTY ROAD 4981
Mailing Address - Street 2:
Mailing Address - City:DESDEMONA
Mailing Address - State:TX
Mailing Address - Zip Code:76445-7102
Mailing Address - Country:US
Mailing Address - Phone:254-243-0400
Mailing Address - Fax:
Practice Address - Street 1:600 COUNTY ROAD 4981
Practice Address - Street 2:
Practice Address - City:DESDEMONA
Practice Address - State:TX
Practice Address - Zip Code:76445-7102
Practice Address - Country:US
Practice Address - Phone:254-243-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional