Provider Demographics
NPI:1023257086
Name:SULLIVAN, MONICA K (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:K
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1955 DIXIE HWY STE N
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2792
Mailing Address - Country:US
Mailing Address - Phone:859-341-6255
Mailing Address - Fax:859-547-1197
Practice Address - Street 1:1955 DIXIE HWY STE N
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2792
Practice Address - Country:US
Practice Address - Phone:859-341-6255
Practice Address - Fax:859-547-1197
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY43346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100163510Medicaid
KY7100163510Medicaid