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General NPI Number Information
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NPI Number | 1467034090
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Entity Type | Individual
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Provider Name | ANNA NICOLE POWELL SULLIVAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 310 COMAL ST STE 200
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City | AUSTIN
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State | TX
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Zip | 78702-4599
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Country | US
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Telephone | 737-270-9500
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Fax | 833-906-2436
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Provider Business Mailing Address
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Address Line | 129 LEACROFT WAY
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City | DURHAM
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State | NC
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Zip | 27703-6703
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Country | US
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Telephone | 919-656-5170
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-11205
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License Number State | NC
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