Provider Demographics
NPI:1487312013
Name:SUTTON, ALIVIA ANNIE (PA)
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:ANNIE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2576 PEARTREE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7800
Mailing Address - Country:US
Mailing Address - Phone:252-548-4258
Mailing Address - Fax:
Practice Address - Street 1:3815 CONLON WAY
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-580-2002
Practice Address - Fax:833-491-4966
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
NC0010-13969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program