Active NPI
Lisa Myers Sullivan, MD
- Anatomic Pathology & Clinical Pathology Physician
- Jackson, MS
National Provider Identifier
1497976617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 23387
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-1530
- NPI assigned
- May 2, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 23387 | MS | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | 0116017500 | VA |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
2500 North State Street
Jackson, MS 39216-4500
Phone (601) 815-9824
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 178238 | Medicaid | AL | |
| 07704363 | Medicaid | MS |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23387 | MS | MD | Anatomic Pathology & Clinical Pathology Physician |
| 0116017500 | VA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447200000000",
"number": "1497976617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 NORTH STATE STREET",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "601-815-9824",
"fax_number": "601-815-0434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "601-984-1530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "LISA",
"middle_name": "MYERS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2015-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MS",
"license": "23387",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "VA",
"license": "0116017500",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "178238",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07704363",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.