Kelli Anne-Marie Sullivan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

216574 Issued in OK

Practice address

4409 N Kickapoo Ave
Shawnee, OK 74804-1206

Phone

(405) 242-4100

NPI assigned

Feb 7, 2024

Sex

Female

Sole proprietor

Yes

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

Enrolled in OK

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oklahoma Pain Management PLLC 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149
• Holdenville General Hospital Hospital, Holdenville, OK, CCN 371321
• Norman Regional Hospital, Norman, OK, CCN 370008
• Mercy Hospital Ada Hospital, Ada, OK, CCN 370020
• Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013

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 and National Provider Directory roles.

• Oklahoma Pain Management PLLC

  • Specialist
  • Oklahoma City, OK
  • NPI 1679760912

  OK

  Medicare reassignment Care Compare group NPD
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Holdenville Hospital Authority

  • Critical Access Hospital
  • Holdenville, OK
  • NPI 1265851455

  Hospital

  Care Compare affiliation
• Mercy Hospital Ada, Inc

  • Ambulance
  • Ada, OK
  • NPI 1831533728

  Hospital

  Care Compare affiliation
• Mercy Hospital Ada, Inc

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1952643306

  Hospital

  Care Compare affiliation
• Mercy Hospital Oklahoma City, Inc

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1184721722

  Hospital

  Care Compare affiliation
• Norman Regional Hospital Authority

  • General Acute Care Hospital
  • Norman, OK
  • NPI 1700882578

  Hospital

  Care Compare affiliation
• St Anthony Shawnee Hospital Inc

  • General Acute Care Hospital
  • Shawnee, OK
  • NPI 1134123193

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1386408656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15266 RED STONE RD",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730207258",
            "telephone_number": "405-313-5261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4409 N KICKAPOO AVE",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041206",
            "telephone_number": "405-242-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLI",
        "middle_name": "ANNE-MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-02-07",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "216574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Streater
• Raeanna Streater
• Jessica L Strong, APRN-FNP
• Daylan Blythe Stuteville
• Bridget Gail Sudderth, LMFT
• Summer Dental Shawnee PLLC
• Craig X Summers, M.D.
• Gayle Swearingen
• Linda Swearingen, LADC
• Michael Tachell

• All providers in Shawnee, OK
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.