Individual
JAMES KEITH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
8081 INNOVATION PARK DR STE 602, FAIRFAX, VA 22031-4867
(571) 472-3270
(571) 472-3271
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
27036
TN
363LF0000X
Family Nurse Practitioner
Primary
0024179997
VA
Other
Enumeration date
02/06/2020
Last updated
08/11/2022
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