Active NPI
Kenneth J. Sutton, LPN
- Licensed Practical Nurse
- Johnston City, IL
National Provider Identifier
1194079517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 043103103
- Practice address
- 14410 Route 37
Johnston City, IL 62951-3166 - Phone
- (618) 983-6911
- NPI assigned
- Nov 7, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 043103103 | IL | Primary |
Addresses
Primary practice location
14410 Route 37
Johnston City, IL 62951-3166
Mailing address
PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-2436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043103103 | IL | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352246400000",
"number": "1194079517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 155",
"city": "CHRISTOPHER",
"state": "IL",
"postal_code": "628220155",
"telephone_number": "618-724-2436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14410 ROUTE 37",
"city": "JOHNSTON CITY",
"state": "IL",
"postal_code": "629513166",
"telephone_number": "618-983-6911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTTON",
"first_name": "KENNETH",
"middle_name": "J.",
"name_prefix": "Mr.",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-07",
"last_updated": "2012-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IL",
"license": "043103103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnston City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.