Provider Demographics
NPI:1487621843
Name:SUTTON, BERRIEN W (NP)
Entity type:Individual
Prefix:
First Name:BERRIEN
Middle Name:W
Last Name:SUTTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:PINELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33945-0360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 360
Practice Address - Street 2:
Practice Address - City:PINELAND
Practice Address - State:FL
Practice Address - Zip Code:33945-0360
Practice Address - Country:US
Practice Address - Phone:615-948-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008322363LA2200X, 363LP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I503726OtherMEDICARE PTAN
TN103I503726OtherMEDICARE PTAN
TN3909303Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TN3909302Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER