Active NPI
Cristen N Sudduth
- Occupational Therapist
- Jackson, MS
National Provider Identifier
1619517869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 20686
- Practice address
- 374 Savanna St
Jackson, MS 39212-5257 - Phone
- (404) 940-4442
- NPI assigned
- Jan 15, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 120331 | TX | |
| Occupational Therapist | 225X00000X | 20686 | CA | Primary |
Addresses
Primary practice location
374 Savanna St
Jackson, MS 39212-5257
Mailing address
374 Savanna St
Jackson, MS 39212-5257
Phone (404) 940-4442
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 |
|---|---|---|---|
| 20686 | CA | MD | Occupational Therapist |
| 120331 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579046400000",
"number": "1619517869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "374 SAVANNA ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392125257",
"telephone_number": "404-940-4442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "374 SAVANNA ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392125257",
"telephone_number": "404-940-4442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUDDUTH",
"first_name": "CRISTEN",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-15",
"last_updated": "2020-01-15",
"certification_date": "2020-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "120331",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "20686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.