LACEY SULLIVAN (NPI# 1962707745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1962707745 |
Entity Type | Individual |
Full Name | LACEY SULLIVAN |
Credential | M.D. |
Practice Address |
2809 Denny Ave Pascagoula MS 39581 |
Mailing Address |
5052 W 4th St Ste 7 Hattiesburg MS 39402-1069 |
Practice Telephone | 2288186063 |
Practice Fax Number | 2288092254 |
Mailing Telephone | 6012612587 |
Mailing Fax Number | 6012647426 |
Enumeration Date | 2011-01-25 |
Last Update Date | 2019-06-03 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
MD.35922 | AL | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
3109 Bienville Blvd, Ocean Springs, MS 395644361 | 2288184056 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194070235 | Lacey Jay Sullivan | Pharmacist | 21132 N 36th Pl, Phoenix, AZ 85050-8386 | 2012-07-15 |
1114412103 | Lacey Sullivan | Dentist | 1141 Jasper Dennis Rd, Clanton, AL 35045 | 2018-06-22 |
1174951503 | Lacey Sullivan | Nurse Practitioner | 618 Maple Valley Dr, Farmington, MO 63640 | 2013-10-22 |
Street Address |
2809 DENNY AVE |
City | PASCAGOULA |
State | MS |
Zip Code | 39581 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154316032 | Debby Ann Koffskey-beech | Social Worker | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2005-09-15 |
1356941397 | Lindsey Nicole Mcfaul | Registered Nurse | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2020-10-28 |
1457958910 | Courtney Tucker | Nurse Practitioner | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2020-10-07 |
1811502628 | Hillary Paige Weaver | Nurse Practitioner | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2020-09-09 |
1316559891 | Ashley Ann Gaffney | Registered Nurse | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2020-08-17 |
1851938898 | Singing River Health System | Pharmacy | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2019-12-10 |
1295379741 | Shelby Alexis Parker | Speech-Language Pathologist | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2019-10-28 |
1366083040 | Kyla Austin Richburg | Nurse Practitioner | 2809 Denny Ave, Pascagoula, MS 39581-5300 | 2019-10-03 |
1124586086 | Anganatte Nicole Williams | Nurse Practitioner | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2019-03-08 |
1205394442 | Kyrissa Malley | Dietitian, Registered | 2809 Denny Ave, Pascagoula, MS 39581-5301 | 2019-03-06 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760945448 | Jacquelyn B Ellison | Nurse Practitioner | 4105 Hospital Road, Ste 103, Pascagoula, MS 39581 | 2019-04-10 |
1104346816 | Jennifer Ngoc Bui | Dentist | 4001 Denny Ave Suite 1, Pascagoula, MS 39581 | 2017-06-23 |
1528486289 | Thomas Stallworth | Nurse Practitioner | 4105 Hospital St Ste 104, Pascagoula, MS 39581 | 2014-03-31 |
1487919957 | Candace Noel Pendowski | Nurse Practitioner | 4211 Hospital St Suite 208, Pascagoula, MS 39581 | 2012-07-10 |
1649548892 | Kim M. Tumminello | Nurse Practitioner | 4253 Denny Avenue, Pascagoula, MS 39581 | 2011-12-02 |
1649547860 | Abrian Norell Flowers | Physical Therapist | 3537 Denny Avenue, Suite 115, Pascagoula, MS 39581 | 2011-11-17 |
1164724118 | Coast To Coast Rehab LLC | Rehabilitation Practitioner | 3537 Denny Ave, Suite 115, Pascagoula, MS 39581 | 2010-11-24 |
1740500958 | Joshua Eric Tucker | Physical Medicine & Rehabilitation | 4105 Hospital St Ste 112b, Pascagoula, MS 39581 | 2010-06-10 |
1720164916 | Vernon W Doster | Family Medicine | 3616 Hospital Street, Suite D, Pascagoula, MS 39581 | 2006-10-31 |
1841387727 | David Bruce Allen | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4300 Hospital Rd, Suite 105, Pascagoula, MS 39581 | 2006-10-10 |
Find all providers in zip 39581 |
Taxonomy Code | 207ZP0102X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pathology |
Specialization | Anatomic Pathology & Clinical Pathology |
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356497416 | Jerry Pascall Moore | Pathology | 146 Road 83, Tupelo, MS 38801-6971 | 2007-01-25 |
1477601177 | Forrest County General Hospital | Pathology | 300 S 29th Ave, Hattiesburg, MS 39401-7127 | 2007-01-08 |
1417027376 | Brad Elliot Wheeler | Pathology | 300 Fisher Street, Biloxi, MS 39534 | 2006-11-08 |
1003904012 | Susan Strong Cannon | Pathology | 15 Summer Trace Blvd, Laurel, MS 39440-2510 | 2006-10-11 |
1386738920 | Celeste Lois Cook-glenn | Pathology | 413 Audubon Ct, Madison, MS 39110-6910 | 2006-10-03 |
1497849533 | Midsouth Pathology Associates | Pathology | 105 Lower Woodville Rd, Natchez, MS 39120 | 2006-10-03 |
1780787143 | Lisa Chandler | Pathology | 1207 Office Park Dr., Suite A, Oxford, MS 38655 | 2006-09-07 |
1215049929 | Clay Broders Calcote | Pathology | 1500 E Woodrow Wilson Dr, Jackson, MS 39216-5116 | 2006-08-31 |
1548206501 | James W Lewis | Pathology | 123 Main St N, Amory, MS 38821-3416 | 2006-06-20 |
1174565469 | Vettaikorumakankav V Vedanarayanan | Pathology | 401 Baptist Dr Ste 301, Madison, MS 39110-2012 | 2006-06-12 |
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City | PASCAGOULA |
Zip Code | 39581 |
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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.