Active NPI
Amanda Rose Sullivan, PMHNP-BC
- Psychiatric/Mental Health Nurse Practitioner
- Concord, MA
National Provider Identifier
1063968709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- RN2262691
- Practice address
- 86 Baker Ave Extension
Suite 100
Concord, MA 01742 - Phone
- (978) 369-1113
- NPI assigned
- Sep 1, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | RN2262691 | MA | Primary |
Addresses
Primary practice location
86 Baker Ave Extension
Suite 100
Concord, MA 01742
Mailing address
86 Baker Ave Extension
Suite 100
Concord, MA 01742
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN2262691 | MA | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1063968709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "86 BAKER AVE EXTENSION",
"address_2": "SUITE 100",
"city": "CONCORD",
"state": "MA",
"postal_code": "01742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 BAKER AVE EXTENSION",
"address_2": "SUITE 100",
"city": "CONCORD",
"state": "MA",
"postal_code": "01742",
"telephone_number": "978-369-1113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "AMANDA",
"middle_name": "ROSE",
"credential": "PMHNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-01",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MA",
"license": "RN2262691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.