Healthcare Provider Details

I. General information

NPI: 1922166735
Provider Name (Legal Business Name): CHERYL A. SULLIVANT R. N. B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 WASHINGTON AVE
KANSAS CITY KS
66112-2152
US

IV. Provider business mailing address

7840 WASHINGTON AVE
KANSAS CITY KS
66112-2152
US

V. Phone/Fax

Practice location:
  • Phone: 913-328-4600
  • Fax:
Mailing address:
  • Phone: 913-328-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number13-31706-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: