Individual
KIMBERLY KAY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
1001 N BROADWAY ST, POTEAU, OK 74953-2609
(918) 649-0731
Mailing address
550 COUNTRY CLUB RD, POTEAU, OK 74953-5219
(417) 848-7976
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0040317
OK
Other
Enumeration date
12/02/2021
Last updated
04/07/2022
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