Provider Demographics
NPI:1750092755
Name:SUTTON, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15055 FAIRFIELD MEADOWS DR # 130-85
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5394
Mailing Address - Country:US
Mailing Address - Phone:346-336-3039
Mailing Address - Fax:832-219-7757
Practice Address - Street 1:15011 MILLER MEADOWS LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4422
Practice Address - Country:US
Practice Address - Phone:346-336-3039
Practice Address - Fax:832-219-7757
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant