KELLY SULLIVAN (CRNP) – Family Nurse Practitioner, NPI 1114392735

KELLY SULLIVAN (CRNP) is a healthcare provider. based in Warren, Pennsylvania. specializing in Family Nurse Practitioner. They hold the professional credentials CRNP. They hold a License No. SP015625 (PA). The NPI Number for KELLY SULLIVAN (CRNP) is 1114392735

Main info

Female
Sole Proprietor
11 Years Of Experience
Accepts Medicare Assignment
Name
KELLY SULLIVAN (CRNP)
NPI
1114392735
Phone
(814) 723-3300
Address
2 W CRESCENT PARK
Enumeration Date
8 December 2015
Last Update Date
3 October 2018

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7243577121
Graduation Year
2015 (11 years ago)
PAC ID
7416253273
Group Practice PAC ID
1153543251
Professional Enrollment ID
I20160304001313
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness75
Years active:10State licenses:1Digital endpointsOther names

Provider Addresses for KELLY SULLIVAN (CRNP)

  • 2 W CRESCENT PARK

    WARREN, PA 163652111

    Phone: (814) 723-3300

    Fax: (814) 726-9412

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-03-04

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160304001313INurse PractitionerPATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99231Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes33743$0
View full utilization report →

Insurance plans in this area (ZIP 16365)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1153543251View full group profile
NameSpecialtyState
-PA
Hospitalist, Internal MedicinePA
Internal MedicinePA
Family Practice, HospitalistPA
Hospitalist, Emergency Medicine, Internal MedicineIN
Hospitalist, Internal MedicineOH
Internal Medicine, HospitalistMI
Internal MedicineIL
Nurse PractitionerSC
Nurse PractitionerPA

Reviews

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Frequently asked questions

What is the 10-digit NPI for KELLY SULLIVAN (CRNP)?
KELLY SULLIVAN (CRNP) — NPI 1114392735 — is the standard way to identify this listing.
Does CMS list KELLY SULLIVAN (CRNP) as active?
Yes — KELLY SULLIVAN (CRNP) is active in the NPI listing used on this page.
What taxonomy line describes KELLY SULLIVAN (CRNP)?
For research purposes, treat KELLY SULLIVAN (CRNP) as Family Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.
Where is KELLY SULLIVAN (CRNP) based?
KELLY SULLIVAN (CRNP) is tied to Warren, Pennsylvania in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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