Individual
JESSICA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
120 MARKET ST, WOODLAND, MS 39776-9104
(662) 456-0111
(662) 456-7335
Mailing address
18780 HIGHWAY 46, MANTEE, MS 39751-9514
(662) 295-1944
(662) 456-7335
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
906933
MS
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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