Individual
KELLY MARY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
195 DODGE ST, BEVERLY, MA 01915-1244
(978) 578-8768
Mailing address
195 DODGE ST, BEVERLY, MA 01915-1244
(978) 578-8768
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN2348656
MA
363LA2100X
Acute Care Nurse Practitioner
RN2348656
MA
Other
Enumeration date
07/28/2026
Last updated
08/02/2026
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