Jacque Lynn Sutton

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.001022 Issued in IL

Practice address

3300 N. Main St.
East Peoria, IL 61611-1562

Phone

(309) 698-8190

Fax

(309) 698-8303

NPI assigned

Jul 11, 2008

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

Other names 1

• Ms. Jacque Lynn Du Bois 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.

• County of Peoria

  • Public Health or Welfare Agency
  • Peoria, IL
  • NPI 1497889661
  NPD (past)

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1437313152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 N. MAIN ST.",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111562",
            "telephone_number": "309-698-8190",
            "fax_number": "309-698-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 N. MAIN ST.",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111562",
            "telephone_number": "309-698-8190",
            "fax_number": "309-698-8303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "JACQUE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.001022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUE",
            "last_name": "DU BOIS",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "R.D., L.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Erinne Snyder, D.T.
• Linda Sok, PHARM.D.
• Amy J Stone, APRN
• Jessica Storck, LPC
• Anna Streenz, PT
• Kelcy Irene Suydam, MS
• Synergy Healthcare Physical Medicine
• Synergy Healthcare Physical Medicine SC
• Tazewell County Resource Centers Inc
• Tazewell Physical Medicine SC

• Registered Dietitian in East Peoria, IL
• Providers in East Peoria, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; 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.