Provider Demographics
NPI:1497061436
Name:SULLIVAN, KARMIN CARTER (RN)
Entity Type:Individual
Prefix:MS
First Name:KARMIN
Middle Name:CARTER
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 PINE HILL DR SE
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-9625
Mailing Address - Country:US
Mailing Address - Phone:740-704-0486
Mailing Address - Fax:
Practice Address - Street 1:5848 PINE HILL DR SE
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9625
Practice Address - Country:US
Practice Address - Phone:740-704-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA177906101YA0400X
OHRN 328815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)