Healthcare Provider Details

I. General information

NPI: 1487046132
Provider Name (Legal Business Name): CORTESSIA BADIE SULLIVAN DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 25TH ST N
BIRMINGHAM AL
35203-2400
US

IV. Provider business mailing address

712 25TH ST N
BIRMINGHAM AL
35203-2400
US

V. Phone/Fax

Practice location:
  • Phone: 205-407-6900
  • Fax:
Mailing address:
  • Phone: 205-407-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1-139399
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2018016965
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018016968
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: