Provider Demographics
NPI:1841542941
Name:SULLIVAN, CARLA (APRN)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 KENTUCKY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3817
Mailing Address - Country:US
Mailing Address - Phone:270-443-5564
Mailing Address - Fax:270-443-5549
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-443-5564
Practice Address - Fax:270-443-5549
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007730363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care