MEDICARE: ADRIENNE CLAIRE 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	363AM0700X	Medical Physician Assistant	6833	TN
2	363AS0400X	Surgical Physician Assistant	6833	TN

General Provider Information

NPI Number	:	1871345090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE CLAIRE SULLIVAN

Provider Business Mailing Address
First Line	:	6077 PRIMACY PKWY STE 140
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5754
Country	:	US
Telephone Number	:	901-725-8347
Fax Number	:	901-259-7637

Provider Business Practice Location Address
First Line	:	6286 BRIARCREST AVE STE 200
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-4023
Country	:	US
Telephone Number	:	901-259-1600
Fax Number	:	901-259-1698

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	12/15/2025

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Directions to “ ADRIENNE CLAIRE SULLIVAN ” Practice Location

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