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General NPI Number Information
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NPI Number | 1366852345
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Entity Type | Individual
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Provider Name | COURTNEY SULLIVAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 505 WOODLAND DRIVE
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City | KERSHAW
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State | SC
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Zip | 29067-1704
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Country | US
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Telephone | 803-282-7465
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Fax | 803-262-0198
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Provider Business Mailing Address
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Address Line | 5545 FLAT CREEK RD
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City | HEATH SPRINGS
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State | SC
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Zip | 29058
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Country | US
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Telephone | 803-320-4797
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22264
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 100813
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License Number State | SC
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