MRS. KATHY REBECCA SULLIVAN (NPI# 1508006149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508006149 |
| Entity Type | Individual |
| Full Name | MRS. KATHY REBECCA SULLIVAN |
| Credential | IDC |
| Practice Address |
Msron Five Medical Department Nolf Ib Building 169 San Diego CA 92135 |
| Practice Telephone | 6194379382 |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2009-02-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841897857 | Kathy Leigh Sullivan | Social Worker | 5 Park Pl Unit 527, Annapolis, MD 21401-3454 | 2020-10-02 |
| 1518268820 | Kathy Sullivan | Day Training/Habilitation Specialist | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2010-11-03 |
| 1598096828 | Kathy Sullivan | Social Worker | 1601 Brenner Ave, Salisbury, NC 28144-2515 | 2010-01-27 |
| 1962668178 | Kathy J. Sullivan | Counselor | 328 W Broadway, Eugene, OR 97401-2826 | 2008-08-07 |
| 1659309086 | Kathy Hollenbaugh Sullivan | Nurse Practitioner | 300 Biddle Ave, Suite 201, Newark, DE 19702-3969 | 2006-06-28 |
| 1326023433 | Kathy M Sullivan | Physician Assistant | 300 State St, #400a, Erie, PA 16507-1427 | 2005-12-12 |
| Street Address |
MSRON FIVE MEDICAL DEPARTMENT NOLF IB BUILDING 169 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053872275 | Erika Hernandez | Dental Hygienist | 600 Mc Cain Blvd, San Diego, CA 92135 | 2019-03-29 |
| 1144723289 | Andrew T Bagby | General Practice | 601 Mc Cain Blvd, San Diego, CA 92135 | 2018-03-15 |
| 1780124792 | Larry Alenbaugh Optometry | Optometrist | Nas North Island Building 2017, San Diego, CA 92135 | 2017-02-24 |
| 1215389507 | Dana Gampel | Optometrist | Nas North Island Nex Building 2017, San Diego, CA 92135 | 2016-07-11 |
| 1801288634 | Branch Medical Clinic Nalf San Clemente Island | Clinic/Center | Wilson Cove, Bldg 60126, San Clemente, CA 92135 | 2015-03-03 |
| 1902213598 | Armin Villanueva | Dental Hygienist | Mcain Blvd Building 600, San Diego, CA 92135 | 2014-07-16 |
| 1114366226 | Jennifer J Miller | Dental Hygienist | Bldg 600 Mccain Blvd, Branch Dental Clinic North Island, San Diego, CA 92135 | 2013-06-21 |
| 1902159916 | Alexis Guadalupe Chavez | Military Health Care Provider | 601 Mccain Blvd Bldg 601, Naval Air Station North Island, Coronado, CA 92135 | 2012-10-16 |
| 1295040426 | Linda Anona Farmer | Military Health Care Provider | Bldg 601 Mccain Blvd Bmc Naval Base Coronado, San Diego, CA 92135 | 2010-08-12 |
| 1659449221 | Edmond Chan Reyes | Military Health Care Provider | Naval Air Station North Island, Bldg 290, Sandiego, CA 92135 | 2006-12-01 |
| Find all providers in zip 92135 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770180648 | Darius Lee Sean Woods | Military Health Care Provider | 6033 Sandy Shore Ct, San Diego, CA 92139-1014 | 2020-10-05 |
| 1174130744 | Daniel Carrera | Military Health Care Provider | 2645 W Canyon Ave Apt 450, San Diego, CA 92123-4700 | 2020-09-28 |
| 1316551740 | Kyle Bode Francis | Military Health Care Provider | 3149 Murray Ridge Rd, San Diego, CA 92123-2917 | 2020-09-02 |
| 1255945069 | Jeremy Lee | Military Health Care Provider | 509 Dennery Rd Apt 145, San Diego, CA 92154-8542 | 2020-08-31 |
| 1013520667 | Rashaad Brown | Military Health Care Provider | 4454 Cherokee Ave Apt 2, San Diego, CA 92116-3611 | 2020-08-24 |
| 1932711934 | Alvaro Daniel Macias | Military Health Care Provider | 8685 Rio San Diego Dr Apt 4344, San Diego, CA 92108-6560 | 2020-08-20 |
| 1689286189 | Charles Luke Morris | Military Health Care Provider | 1675 Beta Ct, San Diego, CA 92126-7060 | 2020-08-18 |
| 1255943635 | Stephon Peyton Frost | Military Health Care Provider | 2654 Mendonca Dr, San Diego, CA 92110-4263 | 2020-08-18 |
| 1184235871 | Jaden Sandi | Military Health Care Provider | Swmi Sfidc Bldg 14 34101 Farenholt Ave, San Diego, CA 92134-0001 | 2020-08-14 |
| 1477178457 | Joseph Hunter Sampson | Military Health Care Provider | 34101 Farenholt Ave #14, San Diego, CA 92134 | 2020-06-15 |
| Find all providers in SAN DIEGO | ||||
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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.