Provider Demographics
NPI:1164290243
Name:TULL, KELCI ELIZABETH (CNP)
Entity Type:Individual
Prefix:
First Name:KELCI
Middle Name:ELIZABETH
Last Name:TULL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KELCI
Other - Middle Name:ELIZABETH
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7109 BACHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-8242
Mailing Address - Country:US
Mailing Address - Phone:937-446-2531
Mailing Address - Fax:
Practice Address - Street 1:7109 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-8242
Practice Address - Country:US
Practice Address - Phone:937-446-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH447193163W00000X
OH0035763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse