Individual
MOLLY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
350 W WOODROW WILSON AVE, JACKSON, MS 39213-7681
(601) 815-0157
(601) 984-5257
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-0157
(601) 984-5257
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901715
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04950045
—
MS
Enumeration date
10/24/2016
Last updated
12/28/2016
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