Provider Demographics
NPI:1164813838
Name:BYLSMA, MOLLY SULLIVAN (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:SULLIVAN
Last Name:BYLSMA
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:SULLIVAN
Other - Last Name:KEARFOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-563-3000
Mailing Address - Fax:270-783-3753
Practice Address - Street 1:121 COLLEGE ST.
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171
Practice Address - Country:US
Practice Address - Phone:270-563-3000
Practice Address - Fax:270-783-3753
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012205363LG0600X, 363LP2300X
MI2014020172363LP2300X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health