Individual
MS. CHANTAL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
8990 LORRAINE RD, GULFPORT, MS 39503-4176
(228) 331-3310
Mailing address
928 COURTHOUSE RD UNIT 6, GULFPORT, MS 39507-4110
(720) 271-0941
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
903677
MS
Other
Enumeration date
02/03/2020
Last updated
03/09/2020
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