Individual
DR. KELLY INGRID SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1602 ROCK PRAIRIE RD, SUITE 340, COLLEGE STATION, TX 77845-8306
(979) 696-4440
(979) 696-7812
Mailing address
1602 ROCK PRAIRIE RD, SUITE 340, COLLEGE STATION, TX 77845-8306
(979) 696-4440
(979) 696-7812
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N1166
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/29/2007
Last updated
05/21/2010
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