MRS. CAROLYN ANNE SULLIVAN AC PNP NPI 1225306269

NPI Information

NPI: 1225306269
Provider Name: MRS. CAROLYN ANNE SULLIVAN, AC PNP
Classification: Nurse Practitioner - 363LP0222X
Entity Type: Individual

Specialization: Pediatrics, Critical Care

PECOS Registration: Yes

Address:
3231 S NATIONAL AVE
SUITE 115
SPRINGFIELD, MO
ZIP 65807
Phone: (417) 885-0824
Get Directions

MRS. Carolyn Anne Sullivan, AC PNP is a pediatrics and critical care nurse practitioner in Springfield, MO. MRS. Carolyn Anne Sullivan, AC PNP NPI is 1225306269. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3231 S NATIONAL AVE
SUITE 115
SPRINGFIELD, MO
ZIP 65807-304
Phone: (417) 885-0824
Fax: (417) 890-4174

The NPI 1225306269 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/5/2011 and was last updated on 11/19/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0222X	Nurse Practitioner	Pediatrics, Critical Care	209009257	ILLINOIS	No
2	363LP0222X	Nurse Practitioner	Pediatrics, Critical Care	2015003901	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1225306269	MEDICAID	MISSOURI
2	132680725	MEDICARE PIN	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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