Kelly Sullivan, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP015625 Issued in PA

Practice address

2 W Crescent Park
Warren, PA 16365-2111

Phone

(814) 723-3300

Fax

(814) 726-9412

NPI assigned

Dec 8, 2015

Last updated

Oct 3, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pennsylvania Department of Human Services

  • Psychiatric Hospital
  • North Warren, PA
  • NPI 1790768471
  Medicare reassignment NPD
• Pennsylvania Department of Public Welfare

  dba Allentown State Hospital

  • Psychiatric Hospital
  • Allentown, PA
  • NPI 1386626919
  NPD
• Warren Medical Group Inc

  • Internal Medicine Physician
  • Warren, OH
  • NPI 1982610788
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1114392735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 W CRESCENT PARK",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163652111",
            "telephone_number": "814-723-3300",
            "fax_number": "814-726-9412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 W CRESCENT PARK",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163652111",
            "telephone_number": "814-723-3300",
            "fax_number": "814-726-9412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-08",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP015625",
            "primary": true
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "PA",
            "license": "SP015625",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juliette Marie Stenz, M.D.
• Emily Joanne May Stowe Sorensen, MA, NCC
• Alex B Strassburg, MD
• Hannah Marie Streich, PTA
• John Strong, CRNA
• Mary I. Summerson, CRNP
• Sunrise Collaborative, LLC.
• Sunrise in-Home Care LLC
• John J Sutton, MD
• Kimberlee Jean Swanson, BSN

• Family Nurse Practitioner in Warren, PA
• Providers in Warren, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.