MEDICARE: MRS. NATALIE KETSIA ALPHONSE SULLIVAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	344149	LA
2	2085R0001X	Radiation Oncology Physician	ME148133	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003255761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE KETSIA ALPHONSE SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1300
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70707-1300
Country	:	US
Telephone Number	:	225-644-3940
Fax Number	:	225-286-7917

Provider Business Practice Location Address
First Line	:	3330 MASONIC DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3841
Country	:	US
Telephone Number	:	318-448-6917
Fax Number	:	225-286-7917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	02/12/2026

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