Provider Demographics
NPI:1255055760
Name:SULLIVAN, ALLISON (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HACKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4508
Mailing Address - Country:US
Mailing Address - Phone:337-330-2576
Mailing Address - Fax:337-417-9909
Practice Address - Street 1:120 N CAROLINA ST
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-3604
Practice Address - Country:US
Practice Address - Phone:225-713-4044
Practice Address - Fax:225-208-1188
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant