Active NPI
Jessica M Sullivan, CNP
- Nurse Practitioner
- Bloomington, IL
National Provider Identifier
1386951085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209008299
- Practice address
- 1405 Eastland Dr
Bloomington, IL 61701-3514 - Phone
- (309) 661-2400
- Fax
- (309) 661-6266
- NPI assigned
- Sep 2, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209008299 | IL | Primary |
Addresses
Primary practice location
1405 Eastland Dr
Bloomington, IL 61701-3514
Mailing address
1405 Eastland Dr
Bloomington, IL 61701-3514
Phone (309) 661-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209008299 | IL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377216000000",
"number": "1386951085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1405 EASTLAND DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013514",
"telephone_number": "309-661-2400",
"fax_number": "309-661-6266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 EASTLAND DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013514",
"telephone_number": "309-661-2400",
"fax_number": "309-661-6266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JESSICA",
"middle_name": "M",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-02",
"last_updated": "2013-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209008299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.