Provider Demographics
NPI:1487972345
Name:SULLIVAN, KATHERINE FRANCES (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FRANCES
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9047 EXECUTIVE PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4625
Mailing Address - Country:US
Mailing Address - Phone:865-773-3555
Mailing Address - Fax:865-297-4240
Practice Address - Street 1:9047 EXECUTIVE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4625
Practice Address - Country:US
Practice Address - Phone:865-773-3555
Practice Address - Fax:865-297-4240
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN173200163W00000X
TN15830363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031503917OtherMEDICARE
TN1524466Medicaid