Active NPI
Katherine Sullivan, PHD, ATC, USAW
- Athletic Trainer
- Detroit, MI
National Provider Identifier
1114334604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- LAT-4054
- Practice address
- 656 W Kirby St
Detroit, MI 48202-3622 - Phone
- (313) 577-9326
- NPI assigned
- Jul 16, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | LAT-4054 | NC | Primary |
Addresses
Primary practice location
656 W Kirby St
Detroit, MI 48202-3622
Mailing address
656 W Kirby St
Detroit, MI 48202-3622
Phone (313) 577-9326
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAT-4054 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1114334604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "656 W KIRBY ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482023622",
"telephone_number": "313-577-9326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "656 W KIRBY ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482023622",
"telephone_number": "313-577-9326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KATHERINE",
"name_prefix": "Dr.",
"credential": "PHD, ATC, USAW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-16",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-4054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.