Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 86574 | OK |
N | 363L00000X | Nurse Practitioner | AP127645 | TX |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 86574 | OK |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 86574 | OK |
NPI | 1417349275 |
---|---|
Provider Name | Kristin Sullivan |
First Address | Tulsa, OK 74104-4041 |
Second Address | Tulsa, OK 74104-4041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2015 |
Last Update Date | 27/10/2020 |