Kelly Sullivan, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11034152 Issued in FL

Practice address

10198 SW Village Pkwy Ste 105
Port Saint Lucie, FL 34987-2592

Phone

(772) 934-4990

NPI assigned

Jul 19, 2024

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

Enrolled in FL

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

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.

• Infinite Medical PC

  • Family Medicine Physician
  • Bristol, RI
  • NPI 1407483175

  FL

  Medicare reassignment NPD
• Tradition Health and Wellness Clinic PLLC

  • Family Medicine Physician
  • Port St Lucie, FL
  • NPI 1720840168
  NPD

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

{
    "created_epoch": "1721347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1407694789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2598 SW DANIA ST",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349537307",
            "telephone_number": "561-345-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10198 SW VILLAGE PKWY STE 105",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349872592",
            "telephone_number": "772-934-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-19",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11034152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lea G Stonom
• Maria Helena Nogueira Stopyra, MD, HHA, MD FACULTY
• Lauren Struble, DPT
• Lisa Michelle Stubbs, SLP
• Sugarcane Dreams Inc
• Sunflower ABA LLC
• Sunny Days Alf,Inc II
• Sunshine Family Alf, LLC
• Sunshine Pathways ABA, LLC
• Sunshine Therapies, LLC

• Family Nurse Practitioner in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.