Healthcare Provider Details

I. General information

NPI: 1568037422
Provider Name (Legal Business Name): JOSIE R SULLIVAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S NATIONAL AVE
SPRINGFIELD MO
65897-0001
US

IV. Provider business mailing address

901 S NATIONAL AVE
SPRINGFIELD MO
65897-0001
US

V. Phone/Fax

Practice location:
  • Phone: 417-836-4000
  • Fax: 888-586-1348
Mailing address:
  • Phone: 417-836-4000
  • Fax: 888-586-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number798116
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025008802
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1129742
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: