Provider Demographics
NPI:1770924094
Name:SUTTON, MISTY DAWN (FNP-C)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015
Mailing Address - Country:US
Mailing Address - Phone:806-681-3720
Mailing Address - Fax:
Practice Address - Street 1:4905 LEXINGTON SQ
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6574
Practice Address - Country:US
Practice Address - Phone:806-353-6700
Practice Address - Fax:806-353-6707
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX317148YVHVOtherMEDICARE UPIN FOR ACCESS MD HEALTHCARE GROUP, PLLC
TX317148YUNJOtherMEDICARE UPIN FOR ACCESS MD, INC.