Individual
SANDY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
59 GRAYS LN, FAYETTEVILLE, TN 37334-6912
(931) 575-9525
Mailing address
59 GRAYS LN, FAYETTEVILLE, TN 37334-6912
(931) 575-9525
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
151501
TN
363L00000X
Nurse Practitioner
Primary
41012
TN
363LA2200X
Adult Health Nurse Practitioner
41012
TN
Other
Enumeration date
04/28/2021
Last updated
04/21/2026
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