Provider Demographics
NPI:1548316573
Name:SUTTON, MARSHA L (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:L
Last Name:SUTTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-7784
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:4602 MACCORKLE AVENUE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-925-4777
Practice Address - Fax:304-388-4870
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32405363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00427353OtherRAIL ROAD MEDICARE
WVWV1183BMedicare PIN
WVWV1183AMedicare PIN
WVWV1183CMedicare PIN
SUNP80392Medicare PIN
P00427353OtherRAIL ROAD MEDICARE
SUNP80391Medicare PIN