Bertha Siedah Sullivn, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

895742 Issued in MS

Practice address

635 Hampton Way Apt C
Jackson, MS 39211-2300

Phone

(662) 466-2208

NPI assigned

Jan 22, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1831729417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 HAMPTON WAY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392112300",
            "telephone_number": "662-466-2208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 HAMPTON WAY APT C",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392112300",
            "telephone_number": "662-466-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVN",
        "first_name": "BERTHA",
        "middle_name": "SIEDAH",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "141-222",
            "primary": false
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "MS",
            "license": "895742",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "895742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS BOARD OF NURSING",
            "identifier": "895742",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Myers Sullivan, MD
• Madison Brooke Sullivan
• Mark Sullivan
• Molly Sullivan
• Sally Sullivan, CRNA
• Ralph E Sulser, M.D.
• Aqfa Sultana
• Dominique Shunta Sulton
• Michal Sumerall, RN
• Donna Summers, LMT

• Registered Nurse in Jackson, MS
• Providers in Jackson, MS by specialty
• Registered Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.