Miklynn Raeanne Pearl Sullivan

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

190022 Issued in OH

Practice address

425 Juliana St
Parkersburg, WV 26101-5352

Phone

(304) 893-9777

NPI assigned

Sep 24, 2025

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Clean & Clear Advantage, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Parkersburg, WV
  • NPI 1790390839
  NPD
• Clean and Clear Advantage

  • Nursing Care Agency
  • Parkersburg, WV
  • NPI 1043056872
  NPD

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

{
    "created_epoch": "1758672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1265305635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 JULIANA ST",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261015352",
            "telephone_number": "304-893-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 JULIANA ST",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261015352",
            "telephone_number": "304-893-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MIKLYNN",
        "middle_name": "RAEANNE PEARL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-24",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "190022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Sullivan
• Jessica L Sullivan, DPT
• Kristina L Sullivan, CRNA
• Lisa Sullivan
• Michael Patrick Sullivan
• Trudy Michelle Sullivan
• Raven J Sully
• Michael S Summerfield, DO
• Abbey Layne Summers
• James Jared Summers

• Licensed Practical Nurse in Parkersburg, WV
• Providers in Parkersburg, WV by specialty
• Licensed Practical Nurse in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.