Provider Demographics
NPI:1710713003
Name:SULLIVAN, VERONICA HARKNESS (PMHNP-BC, DNP)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:HARKNESS
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PMHNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WAY THRU THE WOODS SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1285
Mailing Address - Country:US
Mailing Address - Phone:256-303-8318
Mailing Address - Fax:
Practice Address - Street 1:708 WILL HALSEY WAY STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2566
Practice Address - Country:US
Practice Address - Phone:256-325-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099814363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health