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General NPI Number Information
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NPI Number | 1336621879
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Entity Type | Individual
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Provider Name | KAILA PATTON SULLIVAN CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 4880 HARKEY LN
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2863
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Country | US
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Telephone | 205-333-8222
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Fax | 205-561-1094
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Provider Business Mailing Address
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Address Line | 4880 HARKEY LN
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2863
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Country | US
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Telephone | 205-333-8222
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Fax | 205-561-1094
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-148792
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License Number State | AL
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