Provider Demographics
NPI:1720514847
Name:KUTZ, SASHA LAINE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:LAINE
Last Name:KUTZ
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:MS
Other - First Name:SASHA
Other - Middle Name:LAINE
Other - Last Name:FOSSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1678 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-1159
Mailing Address - Country:US
Mailing Address - Phone:479-799-7515
Mailing Address - Fax:
Practice Address - Street 1:1678 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-1159
Practice Address - Country:US
Practice Address - Phone:479-799-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005127363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner