Provider Demographics
NPI:1144303157
Name:SUTTON, THERESA A (CRNA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:SUTTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 E TENTH ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156
Mailing Address - Country:US
Mailing Address - Phone:620-222-7780
Mailing Address - Fax:
Practice Address - Street 1:216 WEST BIRCH
Practice Address - Street 2:SCKRMC
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005
Practice Address - Country:US
Practice Address - Phone:620-442-2500
Practice Address - Fax:620-441-5968
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55558367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200419000AMedicaid