DR. SUSAN SULLIVAN (NPI# 1154647238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154647238 |
| Entity Type | Individual |
| Full Name | DR. SUSAN SULLIVAN |
| Other Name | MS. SUSAN SULLIVAN DEMIREL |
| Credential | M.D. |
| Practice Address |
3101 Se 14th St Bentonville AR 72712-4900 |
| Practice Telephone | 4796369234 |
| Practice Fax Number | 4796360774 |
| Mailing Telephone | (479) 636-9234 |
| Mailing Fax Number | 4796360774 |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | E-7987 | AR | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Mercy Way, Bella Vista, AR 727143000 | 4796369234 | 4798762856 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679900757 | Susan M Sullivan | Nurse Practitioner | 621 S New Ballas Rd Ste 228a, Saint Louis, MO 63141-8256 | 2013-10-03 |
| 1124382700 | Susan M Sullivan | Massage Therapist | 8655 Main St, Williamsville, NY 14221-7501 | 2012-06-28 |
| 1598031999 | Susan Kathleen Sullivan | Case Manager/Care Coordinator | 3123 Catrina Ln, Annapolis, MD 21403-4340 | 2012-03-29 |
| 1760755524 | Susan Griffin Sullivan | Counselor | 672 Wyndham Crossings Cir, Des Peres, MO 63131-2149 | 2012-02-09 |
| 1871882761 | Susan Lea Sullivan | Lactation Consultant, Non-RN | 6421 Lakewind Cir, Parker, CO 80134 | 2011-03-31 |
| 1366758286 | Susan Carol Sullivan | Marriage & Family Therapist | 4760 Sepulveda Boulevard, Culver City, CA 90230-4820 | 2010-08-30 |
| 1861698144 | Susan Huber Sullivan | Counselor | 407 W Warren St, Shelby, NC 28150-5329 | 2007-06-25 |
| 1427171214 | Susan Emma Sullivan | Developmental Therapist | 210 South Market, Bondville, IL 61815-0133 | 2007-04-09 |
| 1144359746 | Susan B Sullivan | Pharmacist | 9501 E Shea Blvd # Mc139, Scottsdale, AZ 85260-6719 | 2007-03-02 |
| 1144315607 | Susan Elizabeth Sullivan | Psychologist | 13 Welby Road, Suite 2, New Bedford, MA 02745-1132 | 2006-10-03 |
| Street Address |
3101 SE 14TH ST |
| City | BENTONVILLE |
| State | AR |
| Zip Code | 72712-4900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760447353 | Rickey L Mcgath | Family Medicine | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2006-04-18 |
| 1093273195 | Melinda S Tucker | Nurse Practitioner | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2019-03-07 |
| 1568958833 | Meredith R Krohn | Nurse Practitioner | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2018-07-10 |
| 1194210070 | Jaime Marie Holthaus | Nurse Practitioner | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2018-06-25 |
| 1154810612 | Paige Boles | Registered Nurse | 3101 Se 14th St, Bentonville, AR 72712 | 2018-05-09 |
| 1750800827 | Smile Shoppe Bentonville Jeffrey D Rhodes Dds Ms Pllc | Dentist | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2017-09-11 |
| 1750818894 | Tiffany Lynn Shanahan | Nurse Practitioner | 3101 Se 14th St, Bentonville, AR 72712 | 2017-05-19 |
| 1962937102 | Megan Elizabeth Owen | Nurse Practitioner | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2017-04-25 |
| 1982147765 | Tori Layne Abernathy | Nurse Practitioner | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2016-11-28 |
| 1972954600 | Rachel Angulo | Nurse Practitioner | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2016-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662345 | Bentonville Ambulatory Surgery Center, LLC | Pain Medicine | 2902 We Mid-cities Dr, Bentonville, AR 72712 | 2020-09-08 |
| 1942837059 | Amy Crumpton | Counselor | 3504 Se Riveria Road, Bentonville, AR 72712 | 2020-03-26 |
| 1295361509 | Unbridled Holdings LLC | Physical Therapy Assistant | 9900 Price Coffee Rd, Bentonville, AR 72712 | 2020-03-18 |
| 1649803552 | Hanna Kathryn Baxendale | Pediatrics | 2900 Medical Pkwy, Ste #370, Bentonville, AR 72712 | 2020-02-19 |
| 1740746635 | Meredith C Hodges | Counselor | 2508 Se 2oth St, Bentonville, AR 72712 | 2019-02-15 |
| 1609352566 | Tripharma Inc | Pharmacy | 3500 Sw Regional Airport Blvd Ste 2, Bentonville, AR 72712 | 2018-07-13 |
| 1811406747 | Upspring Therapy, LLC | Counselor | 2106 Sw Walton Blvd, Suite B, Bentonville, AR 72712 | 2017-09-22 |
| 1023536836 | Charlotte Yuvonne Hoyle | Case Manager/Care Coordinator | 2005 S.e Walton Blvd., Bentonville, AR 72712 | 2017-08-31 |
| 1508399502 | Rosanna Nicole Rephan | Nurse Practitioner | 3101 14th St, Mercy Convenient Care, Bentonville, AR 72712 | 2017-04-06 |
| 1417305517 | Charlotte Lennette Stephenson | Behavioral Analyst | 2005 S.e. Walton Blvd., Bentonville, AR 72712 | 2016-05-31 |
| Find all providers in zip 72712 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649803552 | Hanna Kathryn Baxendale | Pediatrics | 2900 Medical Pkwy, Ste #370, Bentonville, AR 72712 | 2020-02-19 |
| 1396102679 | Living Tree Pediatrics, Pllc | Pediatrics | 2900 Se Medical Center Parkway, Suite 370, Bentonville, AR 72712 | 2016-01-18 |
| 1669849733 | Rachel Carlisle Macleod | Pediatrics | 4100 Sw I Street, Suite 100, Bentonville, AR 72712 | 2015-08-25 |
| 1578731154 | Julie Lynette Tate | Pediatrics | 2900 Medical Center Pkwy Ste 370, Bentonville, AR 72712-3214 | 2008-02-15 |
| 1013139666 | Jeffrey Allen Savage | Pediatrics | 1502 Se 28th Street, Suite 2, Bentonville, AR 72712 | 2007-05-03 |
| 1487635421 | Whitney Smith Alexander | Pediatrics | 2719 Se I St, Bentonville, AR 72712-3996 | 2005-11-08 |
| 1982081196 | Kristi K Goodson | Pediatrics | 3101 Se 14th St, Bentonville, AR 72712-4900 | 2015-04-27 |
| 1386944791 | Northwest Arkansas Immunization | Pediatrics | 2719 Se I St, Bentonville, AR 72712-3996 | 2010-11-01 |
| 1396987772 | Robin Rae Hudson | Pediatrics | 2719 Se I St, Bentonville, AR 72712-3996 | 2009-03-31 |
| 1851594188 | Matthew K Measel | Pediatrics | 3000 Medical Center Pkwy, Bentonville, AR 72712-3217 | 2007-06-06 |
| Find all providers in BENTONVILLE | ||||
| City | BENTONVILLE |
| Zip Code | 72712 |
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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.