Ms Jerry Sullivan, CFNP is a medicare enrolled "Nurse Practitioner - Family" in Woodland, Mississippi. She graduated from nursing school in 1994 and has 30 years of diverse experience with area of expertise as Nurse Practitioner. Her current practice location is
120 Market Street, Woodland, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(662) 456-0111.
Ms Jerry Sullivan is licensed to practice in Mississippi (license number R739537) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1457409807.
Provider's Profile
| Full Name | Ms Jerry Sullivan |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 30 Years |
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| Location | 120 Market Street, Woodland, Mississippi |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Ms Jerry Sullivan graduated from nursing school in 1994
NPI Data:
- NPI Number: 1457409807
- Provider Enumeration Date: 01/08/2007
- Last Update Date: 02/17/2011
Medicare PECOS Information:
- PECOS PAC ID: 9335336874
- Enrollment ID: I20110419000294
Medical Identifiers
Medical identifiers for Ms Jerry Sullivan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1457409807 | NPI | - | NPPES |
| 0114346 | Medicaid | MS | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | R739537 (Mississippi) | Primary |
Medical Facilities Affiliation
| Facility Name | Location | Facility Type |
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| Kindred At Home | Columbus, MS | Home health agency |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ms Jerry Sullivan allows following entities to bill medicare on her behalf.
| Entity Name | Woodland Clinic Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1629282330
PECOS PAC ID: 9436346053
Enrollment ID: O20110428000315 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Jerry Sullivan is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Ms Jerry Sullivan, CFNP
P. O. Box 186, 120 Market Street,
Woodland, MS 39776
Ph: (662) 456-0111 | Ms Jerry Sullivan, CFNP
120 Market Street,
Woodland, MS 39776
Ph: (662) 456-0111 |
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