O'Sullivan, Kelly Ann
O'Sullivan, Kelly Ann is an individual health care provider with primary practice located at 750 Se Fairwinds Loop , Vancouver WA 98661-8087. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is her primary health care specialty. O'Sullivan, Kelly Ann can be contacted via phone (231) 838-2765.Contact Information
Primary practice address
750 Se Fairwinds Loop
Vancouver WA 98661-8087
Phone: (231) 838-2765
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD60593078 | Washington |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207QG0300X | 4301081068 | Michigan |
Profile Details
| NPI number | 1750332474 |
|---|---|
| LBN Legal business name | O'Sullivan, Kelly Ann |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 15th, 2006 |
| Last updated | Mar 17th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750332474 | NPPES |
| Michigan | Other | N19510003 | MEDICARE INDIV PTAN |
| Michigan | MEDICAID | 5185089 | MEDICARE INDIV PTAN |
| Michigan | Other | ON19510 | MEDICARE INDIV PTAN |
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