Individual
CHASITY RENAE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
10929 OLD HIGHWAY 71, FORT SMITH, AR 72916-8160
(479) 250-1562
Mailing address
3524 ROYAL SCOTS WAY, FORT SMITH, AR 72908-9332
(918) 577-1003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
223808
AR
Other
Enumeration date
04/21/2023
Last updated
04/21/2023
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