Provider Demographics
NPI:1306398409
Name:TULL, KELLY (WHNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TULL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:354 BIRNIE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1109
Mailing Address - Country:US
Mailing Address - Phone:413-794-4744
Mailing Address - Fax:413-787-5273
Practice Address - Street 1:3455 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1187
Practice Address - Country:US
Practice Address - Phone:413-794-8484
Practice Address - Fax:413-794-8477
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT7658363LW0102X
MARN2323729363LW0102X
IN28185781A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health