Healthcare Provider Details

I. General information

NPI: 1396918827
Provider Name (Legal Business Name): HEATHER PEARL SULLIVAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE
BATON ROUGE LA
70809-3748
US

IV. Provider business mailing address

8585 PICARDY AVE
BATON ROUGE LA
70809-3748
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-4000
  • Fax:
Mailing address:
  • Phone: 225-763-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224315
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN154328
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: