Kandis Kay Sullivan

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

3857-33 Issued in WI

Practice address

500 E Veterans St
Tomah, WI 54660-3105

Phone

(608) 372-3971

NPI assigned

Feb 17, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Kandis Kay Powell Former name

Medicare fee-for-service enrollment

Enrolled in WI

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

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Memorial Hospital Inc

  • Rural Health Clinic/Center
  • Neillsville, WI
  • NPI 1619966793
  NPD (past)

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468886400000",
    "number": "1861714917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 CEDAR CREEK DR",
            "city": "ROTHSCHILD",
            "state": "WI",
            "postal_code": "544741461",
            "telephone_number": "715-470-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E VETERANS ST",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546603105",
            "telephone_number": "608-372-3971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KANDIS",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-17",
        "last_updated": "2016-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "108168-030",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WI",
            "license": "3857-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KANDIS",
            "last_name": "POWELL",
            "middle_name": "KAY",
            "prefix": "MS.",
            "credential": "R.N.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paul Stoltz
• Shelby Stone, LCSW
• Sheila Kay Strait, RN
• Shelley Larice Strojny, FPMHNP-BC
• Cassie Sullivan
• Philip A Sweet, M.D.
• Kelly Lynn Swenson, RN
• Shawnette Syvinski, RN
• George Szczerbaniuk
• Ya-Fen Szczesny

• Primary Care Nurse Practitioner in Tomah, WI
• Providers in Tomah, WI by specialty
• Primary Care Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2016; 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.