MEDICARE: KATHLEEN E SULLIVAN

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	2255A2300X	Athletic Trainer		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10704472	OTHER	MS	ATHLETIC TRAINING STUDENT

General Provider Information

NPI Number	:	1255060174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN E SULLIVAN

Provider Business Mailing Address
First Line	:	281 HIGHWAY 7 S
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-8139
Country	:	US
Telephone Number	:	615-948-3271
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 DORMITORY ROW WEST
Second Line	:
City	:	UNIVERSITY
State	:	MS
Zip	:	38677
Country	:	US
Telephone Number	:	615-948-3271
Fax Number	:

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	02/27/2024

Similar Medicare Providers

1578533790 — MR. JEFFREY GLENN MOORE ATC
Practice Location Address:

ROOM 118 FIELDHOUSE , ALL AMERICAN DRIVE
UNIVERSITY, MS
38677

Practice Phone: 662-915-7536
Practice Fax:

1558325134 — MR. TIMOTHY CHRIS MULLINS ATC
Practice Location Address:

1810 MANNINGWAY , UNIVERSITY OF MISSISSIPPI
UNIVERSITY, MS
38677

Practice Phone: 662-915-1841
Practice Fax:

1003853045 — TRAVIS YATES DO
Practice Location Address:

REBEL DRIVE , STUDENT HEALTH CENTER
UNIVERSITY, MS
38677

Practice Phone: 662-915-7274
Practice Fax:

1538196845 — DR. HUBERT EARL SPEARS JR. M.D.
Practice Location Address:

400 REBEL DRIVE
UNIVERSITY, MS
38677

Practice Phone: 662-915-6550
Practice Fax: 662-915-2022

1821027194 — LYNNETTE YVONNE JOHNSON ATC
Practice Location Address:

1 COLISUEM DRIVE , GILLOM SPORTS CENTER
UNIVERSITY, MS
38677

Practice Phone: 662-915-7303
Practice Fax: 662-915-5648

1427083716 — CHAD IAN PERKINS M.S., ATC
Practice Location Address:

DEPARTMENT OF INTERCOLLEGATE ATHLETICS , RM.118 FIELDHOUSE
UNIVERSITY, MS
38677

Practice Phone: 662-915-7536
Practice Fax: 662-915-5275

1639197494 — MARSHALL J CROWTHER M.D.
Practice Location Address:

400 REBEL DRIVE
UNIVERSITY, MS
38677

Practice Phone: 662-915-7274
Practice Fax:

Directions to “ KATHLEEN E SULLIVAN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.