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General NPI Number Information
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NPI Number | 1841835238
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Entity Type | Individual
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Provider Name | JESSICA SULLIVAN CRNP, DNP
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Gender | Female
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Dates
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Enumeration Date | 11/09/2019
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 4330 HIGHWAY 78 E STE 114
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City | JASPER
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State | AL
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Zip | 35501-8955
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Country | US
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Telephone | 205-512-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 424 MATTHEWS DR
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City | JASPER
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State | AL
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Zip | 35503-6052
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Country | US
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Telephone | 205-544-5663
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-162940
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License Number State | AL
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