Kresta Lee Sunderman, CRNP

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

1-173495 Issued in AL

Practice address

12205 County Line Rd Ste C
Madison, AL 35758-7720

Phone

(256) 258-8319

Fax

(256) 489-4070

NPI assigned

Mar 20, 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 AL

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kresta.sunderman.1@30916.direct.athenahealth.com

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.

• Reagan'S Clinic, LLC

  • Developmental - Behavioral Pediatrics Physician
  • Madison, AL
  • NPI 1558123190
  Medicare reassignment NPD

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

{
    "created_epoch": "1710892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1841050606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 CLYDEBANK DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357586246",
            "telephone_number": "254-291-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12205 COUNTY LINE RD STE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357587720",
            "telephone_number": "256-258-8319",
            "fax_number": "256-489-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDERMAN",
        "first_name": "KRESTA",
        "middle_name": "LEE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-20",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "1-173495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sullivan Medical, LLC
• Alicia Monique Sullivan-Smith, LMHC
• Rachel Renay Sullivan
• Veronica Harkness Sullivan, PMHNP-BC, DNP
• Drew Matthew Sumrall, DDS
• Heather Lynn Surber, LCSW
• Daniel Donald Swartz, M.D.
• Jacqueline Y Sylvester, M.D. F.A.C.O.G
• Catherine W Tackett, RPH
• John T Tackett, RPH

• Pediatrics Physician in Madison, AL
• Providers in Madison, AL by specialty
• Pediatrics Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.