Jason Robert Sullivan, RN
Registered Nurse, Psych/Mental Health in Eureka, CA. Individual provider (NPI-1).
NPI number1235784646
StatusActive
Last updated in NPPESAug 4, 2019
Details
- NPI
- 1235784646
- Entity type
- Individual (NPI-1)
- Name
- Jason Robert Sullivan
- Credential
- RN
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 4, 2019
- Last updated
- Aug 4, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WP0808X | Registered Nurse, Psych/Mental Health | RN95135198 | CA | Yes |
Practice location
720 Wood StEureka, CA 95501-4413
Phone 707-268-2990
Mailing address
640 12th St Apt 2Arcata, CA 95521-5864
Phone 707-689-9463
Other practice locations
1100 Butte St
Redding, CA 96001-0852
Redding, CA 96001-0852
Phone 530-244-5400
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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