Basic Information
| Provider Information | |||||||||
| NPI: | 1215026745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTTON | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAMBERT | ||||||||
| OtherFirstName: | DENISE | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 843225 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086331234 | ||||||||
| FaxNumber: | 7083427100 | ||||||||
| Practice Location | |||||||||
| Address1: | 3250 GORDONVILLE RD | ||||||||
| Address2: | SUITE 358 | ||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637035056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733313155 | ||||||||
| FaxNumber: | 5733315096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 02/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | 144174 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 616905 | 01 | MO | BCBS | OTHER | 427318605 | 05 | MO | MEDICAID | 164180 | 01 | MO | HEALTH ALLIANCE | OTHER | 871170 | 01 | MO | HEALTHLINK | OTHER |