Individual
COURTNEY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
505 WOODLAND DRIVE, KERSHAW, SC 29067-1704
(803) 282-7465
(803) 262-0198
Mailing address
5545 FLAT CREEK RD, HEATH SPRINGS, SC 29058
(803) 320-4797
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
100813
SC
363LF0000X
Family Nurse Practitioner
Primary
22264
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366852345
ALL INSURERS
SC
05
—
1366852345
—
SC
Enumeration date
04/30/2014
Last updated
03/30/2022
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