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General NPI Number Information
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NPI Number | 1780563262
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Entity Type | Individual
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Provider Name | SULLIVAN MEAD GILLEY DNP-CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 590 MEDICAL CENTER ROAD
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City | FORT HOOD
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State | TX
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Zip | 76544
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Country | US
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Telephone | 907-854-2413
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Fax |
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Provider Business Mailing Address
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Address Line | 36065 SANTA FE AVE
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City | FORT HOOD
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State | TX
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Zip | 76544-5060
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Country | US
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Telephone | 254-288-8888
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1208365
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1-178883
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License Number State | AL
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