| Sullivan Psychiatric Group, Pllc | |
|
4011 Gardiner Point Dr Ste 101 Louisville KY 40213-1988 | |
| (502) 451-5121 | |
| (502) 451-5125 |
| Full Name | Sullivan Psychiatric Group, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4011 Gardiner Point Dr Ste 101, Louisville, Kentucky |
| Authorized Official Name and Position | John Paul Sullivan (OWNER) |
| Authorized Official Contact | 5024515121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sullivan Psychiatric Group, Pllc 4011 Gardiner Point Dr Suite 101 Louisville KY 40213-1988 Ph: (502) 451-5121 | Sullivan Psychiatric Group, Pllc 4011 Gardiner Point Dr Ste 101 Louisville KY 40213-1988 Ph: (502) 451-5121 |
| NPI Number | 1366879025 |
|---|---|
| Provider Enumeration Date | 09/26/2013 |
| Last Update Date | 11/06/2024 |
| Certification Date | 11/06/2024 |
| Medicare PECOS PAC ID | 4486913530 |
|---|---|
| Medicare Enrollment ID | O20180117001656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366879025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 21704 (Kentucky) | Primary |
| Provider Name | John P Sullivan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356355531 PECOS PAC ID: 1850567439 Enrollment ID: I20120103000486 |
| Provider Name | Ann W Swintosky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174730600 PECOS PAC ID: 0244591485 Enrollment ID: I20180302000840 |
| Provider Name | Amanda Nicole Suell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396399945 PECOS PAC ID: 4082943873 Enrollment ID: I20190903003086 |
| Provider Name | Jane C Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154090454 PECOS PAC ID: 2466850235 Enrollment ID: I20211007003479 |
| Provider Name | Brittany Marie Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558092213 PECOS PAC ID: 5395120307 Enrollment ID: I20220912002332 |
| Provider Name | Amelia L. Graviss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275219503 PECOS PAC ID: 3971957416 Enrollment ID: I20231002002665 |
| Provider Name | Breanna Marie Coulardot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215662135 PECOS PAC ID: 8325482342 Enrollment ID: I20240219000598 |
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