KELSEY SULLIVAN (NPI# 1063904464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063904464 |
| Entity Type | Individual |
| Full Name | KELSEY SULLIVAN |
| Credential | PA |
| Practice Address |
2211 Lomas Blvd Ne Albuquerque NM 87106-2719 |
| Practice Telephone | 4807519804 |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA2018-0032 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | PA2018-0032 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598364283 | Kelsey J Sullivan | Behavior Technician | 35 Halladay Dr, West Suffield, CT 06093-2027 | 2020-10-22 |
| 1487270385 | Kelsey Sullivan | Nurse Practitioner | 799 E 6th St, South Boston, MA 02127-4317 | 2020-06-17 |
| 1568020717 | Kelsey Sullivan | Dentist | 2110 Towne Center Dr, Bellevue, NE 68123-6405 | 2019-06-03 |
| 1255892444 | Kelsey Sullivan | Student in an Organized Health Care Education/Training Program | 263 Farmington Avenue, Farmington, CT 06030-8073 | 2019-03-29 |
| 1528562659 | Kelsey Michelle Sullivan | Student in an Organized Health Care Education/Training Program | 111 Colchester Ave, Burlington, VT 05401-1473 | 2018-03-22 |
| 1194249714 | Kelsey Sullivan | Counselor | 199 S Herlong Ave, Rock Hill, SC 29732-1186 | 2017-07-26 |
| 1225346059 | Kelsey Sullivan | Social Worker | 31882 Camino Capistrano, Suite 108, San Juan Capistrano, CA 92675-3222 | 2010-09-14 |
| 1518153543 | Kelsey Grace Sullivan | Physician Assistant | 1709 Dock St, Tacoma, WA 98402-3204 | 2007-09-24 |
| Street Address |
2211 LOMAS BLVD NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87106-2719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912902016 | Gloria Doherty | Nurse Practitioner | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2005-06-15 |
| 1427659127 | Letitia Tomaszewski | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-08 |
| 1467053116 | Luis Aaron Trillo | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-07 |
| 1215538095 | Rafael Alejandro Fernandez-mancha | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-06 |
| 1144821950 | Jaylee Caruso | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-06 |
| 1508467648 | Christine Hsu Teng | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-05 |
| 1649871641 | Martin Jurado | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-05 |
| 1912508284 | Joshua Marquez | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-04 |
| 1609477850 | Jessica Elena Larsen | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-04 |
| 1619578879 | Kevin A Martinez | Student in an Organized Health Care Education/Training Program | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-11-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679808 | Jorge Licano | Student in an Organized Health Care Education/Training Program | Unmh Hospital 2211 Lomas Blvd Ne, Albuquerque, NM 87106 | 2020-11-04 |
| 1730780032 | Joseph Sanchez | Student in an Organized Health Care Education/Training Program | (unmh Hospital 2211 Lomas Blvd Ne, Albuquerque, NM 87106 | 2020-11-03 |
| 1336746205 | Evan Laub | Pharmacist | 2950 Central Ave. Sw, Albuquerque, NM 87106 | 2020-10-05 |
| 1487203154 | Theresa Martinez | Technician | 5680 Avedon Dr. Se, Albuquerque, NM 87106 | 2019-09-05 |
| 1205300647 | Louis Mayer II | Specialist/Technologist | 1414 University Blvd Tow Diehm Athletic Facility, Albuquerque, NM 87106 | 2019-01-18 |
| 1235633355 | Terrena Grace Vigil Brady | Occupational Therapist | 1001 Yale Blvd, Albuquerque, NM 87106 | 2018-03-22 |
| 1205355195 | Yaritza Ruiz | Specialist/Technologist | 1200 Avenida Cesar Chavez, 231d, Albuquerque, NM 87106 | 2017-09-12 |
| 1457873382 | Cynthia Bluhm | Registered Nurse | 7600 Cedar St Se Ste 7600, Albuquerque, NM 87106 | 2017-07-12 |
| 1295265882 | Hallie Chancellor | Behavior Technician | 1801 Gibson Blvd Se Apt 1046, Albuquerque, NM 87106 | 2017-06-15 |
| 1780111757 | Jiana Hook | Physical Medicine & Rehabilitation | 1414 University Blvd. Se, Albuquerque, NM 87106 | 2017-05-22 |
| Find all providers in zip 87106 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609474550 | Mara Swartzentruber | Physician Assistant | 3310 Linda Vista Ave Se, Albuquerque, NM 87106-1514 | 2020-10-13 |
| 1336757301 | Dailey Doss | Physician Assistant | Raymond G. Murphy Va Medical Center, 1501 San Pedro Se, Albuquerque, NM 87108 | 2020-07-16 |
| 1487287413 | Thomas Clise | Physician Assistant | 629 San Pablo St Ne, Albuquerque, NM 87108-2137 | 2020-02-18 |
| 1912547324 | Kathleen Joyce L'heureux | Physician Assistant | 8124 Ventana Cielo Ave Nw, Albuquerque, NM 87114-5988 | 2020-01-14 |
| 1265097869 | Amber Zoubovitch | Physician Assistant | 7200 Montgomery Blvd Ne Ste 7121, Albuquerque, NM 87109-1510 | 2019-05-08 |
| 1639680739 | Wesley A Parker | Physician Assistant | 3777 Mdg, 2050a Second Street Se, Albuquerque, NM 87117-5522 | 2017-10-16 |
| 1003327487 | Elise Nicole Pedigo | Physician Assistant | 4700 Jefferson St Ne Ste 700, Albuquerque, NM 87109-2132 | 2017-10-12 |
| 1194170605 | Anna Marie Siow | Physician Assistant | 1014 Hummingbird Pl Sw, Albuquerque, NM 87105-8130 | 2016-05-03 |
| 1285032367 | Travis Householder | Physician Assistant | 201 Cedar St Se Ste 4610, Presbyterian Heart Group, Albuquerque, NM 87106-4936 | 2014-12-05 |
| 1508276973 | Stephanie Gonzales | Physician Assistant | 12241 Academy Rd Ne Ste 204, Albuquerque, NM 87111 | 2014-05-06 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87106 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.