Provider Demographics
NPI:1881345874
Name:SULLIVAN, KATHERINE ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER
Mailing Address - Street 2:1530 N 7TH ST SUITE 201
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807
Mailing Address - Country:US
Mailing Address - Phone:812-238-7631
Mailing Address - Fax:
Practice Address - Street 1:1530 N 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1061
Practice Address - Country:US
Practice Address - Phone:812-238-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012202A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily