Provider Demographics
NPI:1467543488
Name:SULLIVAN, KAREN DENISE (APN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 N POPLAR ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2318
Mailing Address - Country:US
Mailing Address - Phone:870-338-6200
Mailing Address - Fax:870-338-6203
Practice Address - Street 1:812 NEWMAN DR
Practice Address - Street 2:SUITE A
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-8950
Practice Address - Country:US
Practice Address - Phone:870-338-6200
Practice Address - Fax:870-338-6203
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARA01848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189877758Medicaid
AR189877758Medicaid