Kathleen M. Sullivan, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

NPP37789 Issued in RI

Practice address

20511 Sunset LN
Lago Vista, TX 78645-6245

Phone

(860) 460-1211

Fax

(860) 760-6113

NPI assigned

Sep 18, 2008

Last updated

May 19, 2026By 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 CT, WA, OR3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/peninsulabehavioral/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.

• Coos County Oregon

  dba Coos Health & Wellness

  • Clinic/Center
  • Coos Bay, OR
  • NPI 1811981053
  Medicare reassignment NPD
• Cornerstone Counseling Center

  • Professional Counselor
  • Waterbury, CT
  • NPI 1316486889
  Medicare reassignment NPD
• Peninsula Behavioral Health

  • Community/Behavioral Health Agency
  • Port Angeles, WA
  • NPI 1760519060
  Medicare reassignment NPD
• Stokes Counseling Services LLC

  • Professional Counselor
  • Naugatuck, CT
  • NPI 1134541469
  Medicare reassignment NPD
• Mindcare Solutions of Texas PA

  • Psychiatry Physician
  • Austin, TX
  • NPI 1396290730
  NPD
• Garden City Psychiatry LLC

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Cranston, RI
  • NPI 1801246616
  NPD (past)

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1306095955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20511 SUNSET LN",
            "city": "LAGO VISTA",
            "state": "TX",
            "postal_code": "786456245",
            "telephone_number": "860-460-1211",
            "fax_number": "860-460-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20511 SUNSET LN",
            "city": "LAGO VISTA",
            "state": "TX",
            "postal_code": "786456245",
            "telephone_number": "860-460-1211",
            "fax_number": "860-760-6113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "95 Sockanosset Cross Rd Ste 305",
            "address_purpose": "LOCATION",
            "city": "Cranston",
            "state": "RI",
            "postal_code": "029205559",
            "country_code": "US",
            "telephone_number": "401-946-6400",
            "fax_number": "833-428-5010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KATHLEEN",
        "middle_name": "M.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "3862",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "RI",
            "license": "NPP37789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primecare Transportation Inc
• Paige Rocker
• Giselle Romo
• Serenity Massage and Bodyworks
• Jerald Grant Sisemore Jr., PHARMD
• Renee Ann Tarlton, PT, MSPT
• Christine M Taylor, PTA
• Teagle Therapy Services, PLLC
• Matthew Robert Teagle, LCSW
• The Guide Counseling and Psychotherapy PLLC

• Psychiatric/Mental Health Nurse Practitioner in Lago Vista, TX
• Providers in Lago Vista, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; 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.