SABRA SULLIVAN (NPI# 1932176641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932176641 |
| Entity Type | Individual |
| Full Name | SABRA SULLIVAN |
| Credential | M.D., PHD. |
| Practice Address |
501 Marshall St Suite 606 Jackson MS 39202-1651 |
| Practice Telephone | 6013558555 |
| Practice Fax Number | 6013552244 |
| Mailing Telephone | 6013558555 |
| Mailing Fax Number | 6013552244 |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2010-06-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
14238 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0114928 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366875437 | Sabra Sullivan | Nurse Practitioner | 103 Myron St, Suite A, West Springfield, MA 01089-1598 | 2013-08-13 |
| Street Address |
501 MARSHALL ST SUITE 606 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-1651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598328684 | Caroline Douglass Peeples | Registered Nurse | 501 Marshall St, Jackson, MS 39202-1651 | 2019-04-15 |
| 1548655053 | Mississippi Urology Outpatient Surgery Center, LLC | Clinic/Center | 501 Marshall St, Suite 201, Jackson, MS 39202-1651 | 2015-04-01 |
| 1639586076 | Baptist Heart | Internal Medicine | 501 Marshall St, Suite 104, Jackson, MS 39202-1651 | 2014-07-17 |
| 1568709574 | Medical Foundation of Central Ms | Surgery | 501 Marshall St, Suite 500, Jackson, MS 39202-1651 | 2013-01-10 |
| 1417291451 | Urogyn Diagnostics LLC | Obstetrics & Gynecology | 501 Marshall St, Suite 600, Jackson, MS 39202-1651 | 2012-11-15 |
| 1548513617 | Southeast Urogyn LLC | Obstetrics & Gynecology | 501 Marshall St, Suite 600, Jackson, MS 39202-1651 | 2012-10-26 |
| 1477825800 | The Medical Foundation of Central Mississippi | Clinic/Center | 501 Marshall St, Suite 100, Jackson, MS 39202-1651 | 2012-02-01 |
| 1265712145 | Laurie Selman Nimon | Nurse Practitioner | 501 Marshall St, Suite 600, Jackson, MS 39202-1651 | 2011-08-23 |
| 1992034771 | Southeast Urogynecology Pa | Urology | 501 Marshall St, Suite 607-a, Jackson, MS 39202-1651 | 2009-12-08 |
| 1053646877 | Barrie E Aden | Audiologist | 501 Marshall St, Suite 602, Jackson, MS 39202-1651 | 2009-10-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 207NS0135X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Procedural Dermatology |
| Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). |
| Notes: Source: American Board of Dermatology, 2007, www.abderm.org [1/1/2008: definition added, source added, title changed] Additional Resources: Some ABMS board certified dermatologists have completed a one-year ACGME approved fellowship in Procedural Dermatology, which has been offered since 2003. At this time the ABD does not offer subspecialty certification in Procedural Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487843199 | The Cutaneous Laser Center | Dermatology | 501 Marshall St Ste 606, Jackson, MS 39202-1650 | 2007-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104980416 | Larry E Millikan | Dermatology | 2321 13th St, Meridian, MS 39301-3940 | 2006-12-21 |
| 1962494294 | Angela Booth Wingfield | Dermatology | 11295 E Taylor Rd, Gulfport, MS 39503-4197 | 2005-08-23 |
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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.