Jessica Lynn Sullivan

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

254179 Issued in KY

Practice address

200 Clinic Dr
Madisonville, KY 42431-1661

Phone

(270) 821-8874

Fax

(270) 821-8883

NPI assigned

Feb 26, 2018

Last updated

Aug 27, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jessica Williams Former name

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• 360Care Services of Kentucky LLC

  • Social Worker
  • Louisville, KY
  • NPI 1669113023

  Clinical

  Medicare reassignment NPD
• 360Care Services of Kentucky LLC

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1174394852
  NPD

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

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1174024020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 614",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422410614",
            "telephone_number": "270-886-2205",
            "fax_number": "270-886-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CLINIC DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311661",
            "telephone_number": "270-821-8874",
            "fax_number": "270-821-8883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3999 Fort Campbell Blvd",
            "address_purpose": "LOCATION",
            "city": "Hopkinsville",
            "state": "KY",
            "postal_code": "422404929",
            "country_code": "US",
            "telephone_number": "270-886-2205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-26",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "254179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "WILLIAMS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erica K Strader, PTA
• Lori Jolene Strader, M.A.ED.
• Tamara L Stroud, APRN
• Alyssa Louise Stubblefield, APRN
• Tore Stuen, P.T.
• Sunrise Children's Services, Inc. (Family Services Madisonville)
• Sunrise Children's Services, Inc. (Lakes and Rivers Region Foster Care - Madisonville)
• Jessica Sweeney, PHARMD
• Synergy Counseling and Wellness Center, LLC
• Robin Tabor, BCBA

• Clinical Social Worker in Madisonville, KY
• Providers in Madisonville, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.