Basic Information
| Provider Information | |||||||||
| NPI: | 1013902527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTO | ||||||||
| FirstName: | CATHLEEN | ||||||||
| MiddleName: | CONNIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 S MAIN ST | ||||||||
| Address2: | P.O. BOX 540 | ||||||||
| City: | JELLICO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377622154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237848492 | ||||||||
| FaxNumber: | 4237848358 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 SUNSET TRL | ||||||||
| Address2: | |||||||||
| City: | JELLICO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377622343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237845771 | ||||||||
| FaxNumber: | 4237846185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 41746 | KY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 43450 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0297024 | 01 | KY | KY MEDICARE | OTHER | FS0838738 | 01 | TN | DEA | OTHER | 41746 | 01 | KY | STATE LICENSE | OTHER | 7100065240 | 05 | KY | MEDICAID | FS1038430 | 01 | KY | DEA | OTHER | 43450 | 01 | TN | STATE LICENSE | OTHER |