Individual
MRS. JACKIE JEAN SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
603 TEACO ROAD, KENNETT, MO 63857-3266
(573) 717-7676
(573) 717-7877
Mailing address
603 TEACO ROAD., KENNETT, MO 63857-3266
(573) 717-7676
(573) 717-7877
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2003013951
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192785
BCBS
MO
05
—
209180900
—
MO
Enumeration date
07/26/2005
Last updated
09/05/2012
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