Individual provider Active NPI

Angela Sutherland

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1154096956
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F04210539 Issued in TX
Practice address
833 S Beckham Ave
Tyler, TX 75701-1905
Phone
(903) 526-4325
NPI assigned
Aug 12, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F04210539 TX Primary

Addresses

Primary practice location

833 S Beckham Ave
Tyler, TX 75701-1905

Mailing address

833 S Beckham Ave
Tyler, TX 75701-1905
Phone (903) 526-4325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210921003335 TX Practitioner - Nurse Practitioner 6103223912 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 590-5611

Hospital & facility affiliations

  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F04210539TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Aug 1, 2023 Accepting new patients
Truhealth, LLC Nurse Practitioner CurrentSince Feb 18, 2022 Accepting new patients
Etmc Physician Group Inc. CurrentSince Aug 1, 2023 Accepting new patients
Wound Management Specialists, LLC Nurse Practitioner CurrentSince Sep 1, 2021 Accepting new patients

Locations

778 Liberty Rd
Flowood, MS 39232
Phone (601) 914-9620

1971 Tennessee Ave N
Parsons, TN 38363
Phone (731) 614-1424

115 Medical Cir
Ste 108
Athens, TX 75751
Phone (903) 670-3185

511 S Bailey St
Electra, TX 76360
Phone (940) 247-7099

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

820 Small St
Grand Prairie, TX 75050
Phone (972) 262-1351

215 Margaret St
Lindale, TX 75771
Phone (903) 480-0101

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

1000 E 5th St
Ste 100
Tyler, TX 75701
Phone (903) 590-5000

833 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-4325

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

1000 E 5th St
Ste 400
Tyler, TX 75701
Phone (903) 593-1749

6850 Rufe Snow Dr
Watauga, TX 76148
Phone (817) 514-4940

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1628726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1154096956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011905",
            "telephone_number": "903-526-4325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011905",
            "telephone_number": "903-526-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "ANGELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-12",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "F04210539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.