Provider Demographics
NPI:1932615689
Name:SUTTON, KUDORA MELODY (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KUDORA
Middle Name:MELODY
Last Name:SUTTON
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:DR
Other - First Name:KUDORA
Other - Middle Name:MELODY
Other - Last Name:MAIZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-C
Mailing Address - Street 1:1539 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1306
Mailing Address - Country:US
Mailing Address - Phone:304-366-9100
Mailing Address - Fax:610-347-4737
Practice Address - Street 1:608 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4210
Practice Address - Country:US
Practice Address - Phone:304-594-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN91678NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV91678OtherWV RN LICENSE
WVAPRN91678NPOtherWV NP LICENSE
WVAPRN91678NPOtherWV NP LICENSE
WVAPRN91678NPOtherWV NP LICENSE
VA0001276514OtherVA RN LICENSE