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General NPI Number Information
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NPI Number | 1144692823
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Entity Type | Individual
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Provider Name | HEATHER SULLIVAN NP
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Gender | Female
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 10705 MILWAUKEE AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-6153
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Country | US
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Telephone | 806-701-5210
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Fax | 806-701-5211
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Provider Business Mailing Address
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Address Line | 2804 N LOOP 289
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City | LUBBOCK
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State | TX
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Zip | 79415-1410
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Country | US
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Telephone | 806-744-7223
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Fax | 806-740-3325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP128821
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License Number State | TX
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