Healthcare Provider Details

I. General information

NPI: 1790625614
Provider Name (Legal Business Name): CALEB SULLIVAN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N ALSTON ST
FOLEY AL
36535-2208
US

IV. Provider business mailing address

1625 N ALSTON ST
FOLEY AL
36535-2208
US

V. Phone/Fax

Practice location:
  • Phone: 251-215-4004
  • Fax:
Mailing address:
  • Phone: 251-215-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-192597
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: