Susan Southerton, RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

420717-1 Issued in NY

Practice address

256 Sunset Lake Rd
Liberty, NY 12754-2847

Phone

(845) 513-2012

Fax

(845) 513-2177

NPI assigned

Oct 19, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508371200000",
    "number": "1003327875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 SUNSET LAKE RD",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127542847",
            "telephone_number": "845-513-2012",
            "fax_number": "845-513-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 SUNSET LAKE RD",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127542847",
            "telephone_number": "845-513-2012",
            "fax_number": "845-513-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHERTON",
        "first_name": "SUSAN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-19",
        "last_updated": "2017-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "NY",
            "license": "420717-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kristie Sneckenberg, LMHC
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• Jacalyn D Space
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• Administrator Registered Nurse in Liberty, NY
• Providers in Liberty, NY by specialty
• Administrator Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.