Sullivan, Carisa R

Sullivan, Carisa R is an individual health care provider with primary practice located at 6010 W Amarillo Blvd Bldg West , Amarillo TX 79106-1990. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Sullivan, Carisa R can be contacted via phone (806) 355-9703.

Contact Information

Primary practice address
6010 W Amarillo Blvd Bldg West Amarillo TX 79106-1990
Phone: (806) 355-9703
Fax: (806) 468-1500
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP129122 Texas

Profile Details

NPI number 1326418658
LBN Legal business name Sullivan, Carisa R
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 29th, 2015
Last updated Feb 11th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326418658 NPPES
Oklahoma MEDICAID 200615620 A
Oklahoma MEDICAID 77376714
Oklahoma MEDICAID 352922401
Oklahoma MEDICAID 352922402

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