Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Laura Nastassja Sullivan, PA

Individual provider Physician Assistant · NPI 1124455704

Laura Nastassja Sullivan, PA is a Physician Assistant in Apex, North Carolina. Qualified in 2013, 13 years ago. Practices with North Carolina Mg LLC, a 712-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
13
Licensed in
NC
In the registry since
2013
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1011 Pemberton Hill Rd Ste 101
Apex, NC 27502-4266
Phone: (919) 620-4700
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11200 Governor Manly Way Ste 114, Raleigh, NC 27614-7360 — (919) 570-7660

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-04483 (NC)

Record details

NPI number1124455704
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 27, 2013
Last updated in NPPESJune 1, 2022
Certification dateJune 1, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice North Carolina Mg Llc — 712 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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