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NPI Code Detail

MEDICARE: JESSICA SULLIVAN

MEDICARE: JESSICA 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
1103K00000XBehavior Analyst1-23-65592NC

General Provider Information

NPI Number : 1326708645
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SULLIVAN
Provider Business Mailing Address
First Line : 5493 ROBMONT DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28306-2674
Country : US
Telephone Number : 919-538-3510
Fax Number :
Provider Business Practice Location Address
First Line : 5493 ROBMONT DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28306-2674
Country : US
Telephone Number : 919-538-3510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2021
Last Update Date : 05/22/2026

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