Kathy Rebecca Sullivan, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

Msron Five Medical Department
Nolf Ib Building 169
San Diego, CA 92135

Phone

(619) 437-9382

NPI assigned

Feb 23, 2009

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1508006149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MSRON FIVE MEDICAL DEPARTMENT",
            "address_2": "NOLF IB BUILDING 169",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MSRON FIVE MEDICAL DEPARTMENT",
            "address_2": "NOLF IB BUILDING 169",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92135",
            "telephone_number": "619-437-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KATHY",
        "middle_name": "REBECCA",
        "name_prefix": "Mrs.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-23",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Patrick Sullivan Jr.
• Eva Sullivan, PHARMD
• Jeff Allen Sullivan, PH.D., ATC
• John Philip Sullivan, M.D
• Julie Marie Sullivan, M.D.
• Keith Patrick Sullivan
• Kelly Ann Sullivan, M.A., M.F.T.
• Kevin Brian Sullivan, DO
• Kyle Kathleen Sullivan
• Leigh Sullivan

• Independent Duty Corpsman in San Diego, CA
• Providers in San Diego, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.