Provider Demographics
NPI:1386216679
Name:SULLIVAN, ALEXIS (CNP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8306
Mailing Address - Country:US
Mailing Address - Phone:859-486-8582
Mailing Address - Fax:
Practice Address - Street 1:1020 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8306
Practice Address - Country:US
Practice Address - Phone:859-486-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015918363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner