Individual
KELLI ANNE-MARIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4409 N KICKAPOO AVE, SHAWNEE, OK 74804-1206
(405) 242-4100
Mailing address
15266 RED STONE RD, CHOCTAW, OK 73020-7258
(405) 313-5261
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
216574
OK
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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