Basic Information
| Provider Information | |||||||||
| NPI: | 1417349275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 S UTICA AVE STE 460 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185795749 | ||||||||
| FaxNumber: | 9185795762 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 S UTICA AVE STE 460 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185795749 | ||||||||
| FaxNumber: | 9185795762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2015 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 86574 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 163W00000X | 792822 | TX | N | Nursing Service Providers | Registered Nurse | 363L00000X | 86574 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | AP127645 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LC0200X | 86574 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
No ID Information.