Individual
CASEY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1055 N 300 W, STE 108, PROVO, UT 84604-3381
(801) 357-7377
(801) 357-7378
Mailing address
1055 N 300 W, SUITE 108, PROVO, UT 84604-3381
(801) 357-7377
(801) 357-7378
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
167224
CO
363LF0000X
Family Nurse Practitioner
Primary
7344974-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
606223
—
CO
Enumeration date
08/24/2006
Last updated
07/31/2023
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