Stacy Sutton

Primary specialty

DriverTaxonomy code 172A00000X

License

RR064991 Issued in OH

Practice address

529 Streamwater Dr
Blacklick, OH 43004-8138

Phone

(380) 250-2690

NPI assigned

Apr 18, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Latisha Sutton Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Sellnis Corp

  • Transportation Network Company
  • Blacklick, OH
  • NPI 1255028593
  NPD Authorized official

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1295421675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 STREAMWATER DR",
            "city": "BLACKLICK",
            "state": "OH",
            "postal_code": "430048138",
            "telephone_number": "380-250-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 STREAMWATER DR",
            "city": "BLACKLICK",
            "state": "OH",
            "postal_code": "430048138",
            "telephone_number": "380-250-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "STACY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "OH",
            "license": "RR064991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LATISHA",
            "last_name": "SUTTON",
            "prefix": "MRS.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Driver in Blacklick, OH
• Providers in Blacklick, OH by specialty
• Driver in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; 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.