Individual
DEBORAH S SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
595 MAIN ST E, MEADVILLE, MS 39653-9233
(601) 384-3199
(601) 384-3950
Mailing address
595 MAIN ST E, P.O. BOX 636, MEADVILLE, MS 39653-9233
(601) 384-3199
(601) 384-3950
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R524239
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120619
—
MS
Enumeration date
09/19/2006
Last updated
04/02/2014
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