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Individual

KELLY SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
2 W CRESCENT PARK, WARREN, PA 16365-2111
(814) 723-3300
(814) 726-9412
Mailing address
2 W CRESCENT PARK, WARREN, PA 16365-2111
(814) 723-3300
(814) 726-9412

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP015625
PA
364SF0001X
Family Health Clinical Nurse Specialist
SP015625
PA

Other

Enumeration date
12/08/2015
Last updated
10/03/2018
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