Individual
HENSON SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAA
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-4619
(843) 792-1414
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT DEPARTMENT, KANSAS CITY, MO 64108-4619
(816) 234-3000
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
2022039543
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2022
Last updated
07/18/2025
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