MRS. KELLY SULLIVAN APRN
NPI 1407694789
Nurse Practitioner - Family in Port Saint Lucie, FL
About Mrs. Kelly Sullivan Aprn NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. KELLY SULLIVAN APRN (NPI 1407694789) is an individual family provider in Port Saint Lucie, Florida, licensed in Florida (11034152) and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mrs. Kelly Sullivan Aprn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Sullivan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Bristol, RI 02809
- Reassigned Medicare billing, Florida enrollment
- 117 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 34987 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PORT ST LUCIE, FL 34987
PORT ST LUCIE, FL 34987
PORT SAINT LUCIE, FL 34987
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Sullivan's NPI number?
The NPI number for Kelly Sullivan is 1407694789. It was assigned to this individual provider in the NPPES registry on July 19, 2024.
Where is Kelly Sullivan located?
Kelly Sullivan practices at 10198 SW Village Pkwy Ste 105, Port Saint Lucie, FL 34987. The listed phone number is (772) 934-4990.
What is Kelly Sullivan's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Kelly Sullivan enrolled in Medicare?
Yes. Kelly Sullivan is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Sullivan's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Sullivan reassigns Medicare benefits to Infinite Medical PC (Bristol, RI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Sullivan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Sullivan was last updated on July 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mrs. Kelly Sullivan, APRN · NPI 1407694789
Family physician in Port Saint Lucie, Florida. Individual provider, active in the CMS NPPES registry since July 19, 2024.
## Identity
- **NPI:** 1407694789 (Entity type: Individual)
- **Enumerated:** July 19, 2024
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 11034152 (Florida)
- **Sole proprietor:** No
## Practice location
- **Address:** 10198 SW VILLAGE PKWY STE 105, Port Saint Lucie, FL 34987-2592
- **Phone:** (772) 934-4990
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Infinite Medical PC (NPI 1407483175, Bristol, RI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 19, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1407694789) · Data from the CMS NPPES public registry.