Provider Demographics
NPI:1336621879
Name:SULLIVAN, KAILA PATTON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KAILA
Middle Name:PATTON
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 HARKEY LN
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2863
Mailing Address - Country:US
Mailing Address - Phone:205-333-8222
Mailing Address - Fax:205-561-1094
Practice Address - Street 1:4880 HARKEY LN
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2863
Practice Address - Country:US
Practice Address - Phone:205-333-8222
Practice Address - Fax:205-561-1094
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148792363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics