KELLY ANN O'SULLIVAN (NPI# 1750332474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750332474 |
| Entity Type | Individual |
| Full Name | KELLY ANN O'SULLIVAN |
| Credential | M.D. |
| Practice Address |
750 Se Fairwinds Loop Vancouver WA 98661-8087 |
| Practice Telephone | 2318382765 |
| Mailing Telephone | 2318382765 |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | MD60593078 | WA | Allopathic & Osteopathic Physicians |
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
4301081068 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MEDICARE INDIV PTAN | N19510003 | 01 |
| MI | 5185089 | 05 | |
| MI | MEDICARE GROUP PTAN | ON19510 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3400 Main St, Vancouver, WA 986632223 | 3606965232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043844053 | Kelly Catherine O'sullivan | Social Worker | 4580 Broadway Frnt 1, New York, NY 10040-2105 | 2020-02-28 |
| 1467488072 | Kelly O'sullivan | Physician Assistant | 3 Silent Meadow Ln, Dept of Medicine, Lancaster, NY 14086-3430 | 2006-06-24 |
| 1144615519 | Kelly O'sullivan | Occupational Therapist | 6530 33rd Ave Nw, Olympia, WA 98502-8846 | 2015-04-02 |
| 1881007201 | Kelly O'sullivan | Student in an Organized Health Care Education/Training Program | 228 Linda Ave, Hawthorne, NY 10532-2050 | 2014-06-03 |
| Street Address |
750 SE FAIRWINDS LOOP |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98661-8087 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982228417 | Cynthia Ann Holt | Social Worker | 4608 Ne 47 Street, Vancouver, WA 98661 | 2020-06-01 |
| 1235793027 | James Dostert | Counselor | 1601 E 4th Blvd. Bldg. 17, Ste A212, Vancouver, WA 98661 | 2019-04-26 |
| 1306305289 | Kathryn Susanne Scott | Social Worker | Attn: Kathryn Scott, V3cnh, 1601 E. Fourth Plain Blvd., Vancouver, WA 98661 | 2019-03-19 |
| 1952860637 | Alice Rogers | Occupational Therapist | Vancouver Public Schools, 2901 Falk Rd., Vancouver, WA 98661 | 2019-03-13 |
| 1053878538 | Paula Moore | Counselor | 9626 Ne Fourth Plain Blvd, Vancouver, WA 98661 | 2019-02-21 |
| 1558825729 | Cassandra Marie Nichols | Counselor | 1601 E 4th Blvd, Vancouver, WA 98661 | 2019-01-22 |
| 1548734148 | Lisa Kelly | Counselor | 1601 E 4th Blvd., Vancouver, WA 98661 | 2019-01-16 |
| 1518444025 | Columbia Pharmacy | Pharmacy | 2700 Ne Andresen Rd Ste E3, Vancouver, WA 98661 | 2018-07-26 |
| 1023505229 | Ellen Barbour | Counselor | 1601 E 4th Plain Blvd Bldg. 17, Ste A212, Vancouver, WA 98661 | 2018-04-13 |
| 1679096325 | Brian Scott Coleman | Counselor | 1601 East Fourth Plain Blvd., Bldg #17, Ste. A212, Vancouver, WA 98661 | 2017-07-24 |
| Find all providers in zip 98661 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750921193 | Bastion Health PC | Family Medicine | 4515 Logan Dr Ne, Lacey, WA 98516-1350 | 2020-01-14 |
| 1023654548 | Jared Edward Bruder | Family Medicine | 5015 S Regal St Apt B2014, Spokane, WA 99223-7906 | 2019-11-19 |
| 1699010314 | Association of University Physicians | Family Medicine | 325 9th Ave E, Hmc Senior Care Clinic, Seattle, WA 98104-2420 | 2012-12-06 |
| 1346570728 | Scott Andrew Balson | Family Medicine | 1901 S Union Ave # 244, Tacoma, WA 98405-1702 | 2010-01-06 |
| 1992953277 | Gary Eugene Gaffield | Family Medicine | 44416 Dalles Rd, Concrete, WA 98237-9431 | 2008-08-28 |
| 1598982324 | The Clinic At Panorama City,ps | Family Medicine | 4044 15th Ln Se, Suite A, Lacey, WA 98503 | 2007-04-20 |
| 1245380468 | Assadullah Kazemi | Family Medicine | 4515 Mlk Way, Providence Elderplace, Seattle, WA 98108 | 2007-01-11 |
| 1063577039 | Troyer Eric J H Md | Family Medicine | 7728 12th Ave Nw, Seattle, WA 98117-4135 | 2006-12-27 |
| 1205907789 | Marcus E Kuypers Md PC | Family Medicine | 104 S First, Suite B, La Conner, WA 98257-0840 | 2006-11-13 |
| 1760553028 | Laurie J Mercier Md Ps | Family Medicine | 13553 Ne 54th Pl, Bellevue, WA 98005-1037 | 2006-11-10 |
| Find all providers with the same taxonomy | ||||
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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.