Provider Demographics
NPI:1003255761
Name:ALPHONSE SULLIVAN, NATALIE KETSIA (MD)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:KETSIA
Last Name:ALPHONSE SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70707-1300
Mailing Address - Country:US
Mailing Address - Phone:225-644-3940
Mailing Address - Fax:225-286-7917
Practice Address - Street 1:3330 MASONIC DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3841
Practice Address - Country:US
Practice Address - Phone:318-448-6917
Practice Address - Fax:225-286-7917
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
FLME1481332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program