| Doctor Name: | AMY SULLIVAN |
| NPI Number: | 1053735639 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | A004030 |
| Business Practice Address: | 5830 Highway 5 Cabot, AR - 720237328 |
| Business Phone Number: | 5019411376 |
| Business Fax Number: | 8705693594 |
| Mailing Address: | 117 S 2nd St, Po Box 497 AUGUSTA |
| State: | AR |
| Postal Code: | 720062309 |
| Phone Number: | 8703472534 |
| Fax Number: | 8703473492 |
| NPI Enumeration Date: | 02/18/2014 |
| NPI Last Update Date: | 02/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A004030 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |