Individual provider Active NPI

Karen Denise Sullivan, APN

  • Family Nurse Practitioner
  • Helena, AR
National Provider Identifier
1467543488
Registry record updated Mar 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A01848 Issued in AR
Practice address
812 Newman Dr
Suite a
Helena, AR 72342-8950
Phone
(870) 338-6200
Fax
(870) 338-6203
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A01848 AR Primary

Addresses

Primary practice location

812 Newman Dr
Suite a
Helena, AR 72342-8950

Mailing address

15 N Poplar St
Suite a
Marianna, AR 72360-2318
Phone (870) 338-6200

Other identifiers 1

IdentifierTypeStateIssuer
189877758MedicaidAR

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A01848ARMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
P. Reddy Tukivakala, M.D., P.a. CurrentSince Apr 14, 2012 Accepting new patients
Northeast Arkansas Clinic, PA Past Accepting new patients

Locations

810A Newman Dr
Helena, AR 72342
Phone (870) 338-7411

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456876800000",
    "number": "1467543488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 N POPLAR ST",
            "address_2": "SUITE A",
            "city": "MARIANNA",
            "state": "AR",
            "postal_code": "723602318",
            "telephone_number": "870-338-6200",
            "fax_number": "870-338-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 NEWMAN DR",
            "address_2": "SUITE A",
            "city": "HELENA",
            "state": "AR",
            "postal_code": "723428950",
            "telephone_number": "870-338-6200",
            "fax_number": "870-338-6203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KAREN",
        "middle_name": "DENISE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2016-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A01848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189877758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Helena, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; 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.