MEDICARE: HEATHER SULLIVAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP128821	TX

General Provider Information

NPI Number	:	1144692823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SULLIVAN NP

Provider Business Mailing Address
First Line	:	2804 N LOOP 289
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79415-1410
Country	:	US
Telephone Number	:	806-744-7223
Fax Number	:	806-740-3325

Provider Business Practice Location Address
First Line	:	10705 MILWAUKEE AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-6153
Country	:	US
Telephone Number	:	806-701-5210
Fax Number	:	806-701-5211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2015
Last Update Date	:	03/01/2023

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Directions to “ HEATHER SULLIVAN NP” Practice Location

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